Provider Demographics
NPI:1225872773
Name:HENDERSON, CHALAUNDRA JAQUITA
Entity type:Individual
Prefix:MS
First Name:CHALAUNDRA
Middle Name:JAQUITA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-5523
Mailing Address - Country:US
Mailing Address - Phone:228-304-3288
Mailing Address - Fax:
Practice Address - Street 1:784 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-5523
Practice Address - Country:US
Practice Address - Phone:228-304-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide