Provider Demographics
NPI:1902416811
Name:HENDERSON, KRYSTAL MURPHY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:MURPHY
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16076 HIGHWAY 929
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5538
Mailing Address - Country:US
Mailing Address - Phone:225-200-5493
Mailing Address - Fax:
Practice Address - Street 1:31450 WALKER RD N
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-5105
Practice Address - Country:US
Practice Address - Phone:225-664-9711
Practice Address - Fax:225-665-4415
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA290217164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse