Basic Information
| Provider Information | |||||||||
| NPI: | 1073960647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENDRIX | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 KATHERINE DR STE G | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392328857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019339521 | ||||||||
| FaxNumber: | 3343954115 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 HIGHWAY 61 N | ||||||||
| Address2: | |||||||||
| City: | VICKSBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391838211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018335000 | ||||||||
| FaxNumber: | 6018835137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2016 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 885642 | MS | N | Nursing Service Providers | Registered Nurse | 367500000X | 901397 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.