DR. LARRY A HENDERSON MD NPI 1215976022

NPI Information

  • NPI: 1215976022
  • Provider Name: DR. LARRY A HENDERSON, MD
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 92 RATLIFF ST
    LUCEDALE, MS
    ZIP 39452
  • Phone: (601) 947-8181

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NPI Details

DR. Larry A Henderson, MD is a family medicine in Lucedale, MS with 25 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Larry A Henderson, MD NPI is 1215976022. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Graduation Year:2001

The provider's business location address is:

92 RATLIFF ST
LUCEDALE, MS
ZIP 39452-537
Phone: (601) 947-8181
Fax: (601) 947-4411

The NPI 1215976022 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/6/2006 and was last updated on 12/24/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine19697MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
109435313MEDICAIDMISSISSIPPI
2270736500MEDICAIDFLORIDA
301-01886OTHERALABAMAUNITED HEALTH CARE
4009966685MEDICAIDALABAMA
5P00696992OTHERMISSISSIPPIPALMETTO GBA
651523926OTHERALABAMABLUE CROSS
71502324MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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