TYKERRIA RENEE HENDERSON
NPI 1104775865
Nurse Practitioner - Family in Vicksburg, MS
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. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Tykerria Renee Henderson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 39180 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
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.
Is Tykerria Henderson enrolled in Medicare?
Yes. Tykerria Henderson is registered in the Medicare PECOS enrollment system.
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 32 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.
# Tykerria Renee Henderson · NPI 1104775865
Family physician in Vicksburg, Mississippi. Individual provider, active in the CMS NPPES registry since January 26, 2026.
## Identity
- **NPI:** 1104775865 (Entity type: Individual)
- **Enumerated:** January 26, 2026
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 908689 (Mississippi)
- **Sole proprietor:** No
## Practice location
- **Address:** 3317 PEMBERTON SQUARE BLVD, Vicksburg, MS 39180-5578
- **Phone:** (601) 636-1173
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** September 30, 2026
---
Source: [NPI Profile](https://npiprofile.com/npi/1104775865) · Data from the CMS NPPES public registry.