Provider Demographics
NPI:1649098724
Name:HENRY, JILLIAN RAE (WHNP STUDENT)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:RAE
Last Name:HENRY
Suffix:
Gender:F
Credentials:WHNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HARVEST CT
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-2742
Mailing Address - Country:US
Mailing Address - Phone:337-517-9768
Mailing Address - Fax:
Practice Address - Street 1:110 HARVEST CT
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-2742
Practice Address - Country:US
Practice Address - Phone:337-517-9768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN150407390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program