Provider Demographics
NPI:1275337784
Name:HENDERSON, LORI YVETTE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:YVETTE
Last Name:HENDERSON
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:YVETTE
Other - Last Name:CALVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8888 CHIMNEYROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4069
Mailing Address - Country:US
Mailing Address - Phone:901-219-9474
Mailing Address - Fax:
Practice Address - Street 1:8888 CHIMNEYROCK BLVD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4069
Practice Address - Country:US
Practice Address - Phone:901-219-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty