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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

TYKERRIA RENEE HENDERSON
NPI 1104775865
Nurse Practitioner - Family in Vicksburg, MS

Active since January 26, 2026
3317 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180(601) 636-1173 Get Directions Write a Review

NPPES record last updated: September 30, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Sep 30, 2026, Jan 26, 2026 (2 updates tracked since 2026).

About Tykerria Renee Henderson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYKERRIA RENEE HENDERSON (NPI 1104775865) is an individual family provider in Vicksburg, Mississippi, licensed in Mississippi (908689) and active in the NPI registry since January 2026.

NPPES Registry Identity

NPI1104775865
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameTYKERRIA RENEE HENDERSON
Location Address3317 PEMBERTON SQUARE BLVDVicksburg, MS 39180-5578
Mailing Address3317 Pemberton Square BlvdVicksburg, MS 39180-5578 · (601) 636-1173
Phone(601) 636-1173
Sole ProprietorNo
Enumeration DateJanuary 26, 2026
Last NPPES UpdateSeptember 30, 20262 updates tracked since enumeration
NPPES CertifiedSeptember 30, 2026
✔ NPI 1104775865 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in MS · 908689
3317 PEMBERTON SQUARE BLVD, Vicksburg, MS 39180
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Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VICKSBURG CLINIC LLC
Clinic/Center (Rural Health)
3317 PEMBERTON SQUARE BLVD
VICKSBURG, MS 39180
Warren County (601) 636-1173
ALLEN BRELAND YELVERTON
Nurse Practitioner
3317 PEMBERTON SQUARE BLVD
VICKSBURG, MS 39180
Warren County (601) 636-1173
MADELEINE GAUL
Nurse Practitioner (Family)
3317 PEMBERTON SQUARE BLVD
VICKSBURG, MS 39180
Warren County (601) 636-1173

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tykerria Henderson's NPI number?

The NPI number for Tykerria Henderson is 1104775865. It was assigned to this individual provider in the NPPES registry on January 26, 2026.

Where is Tykerria Henderson located?

Tykerria Henderson practices at 3317 Pemberton Square Blvd, Vicksburg, MS 39180. The listed phone number is (601) 636-1173.

What is Tykerria Henderson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Tykerria Henderson was last updated on September 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.