KELLI SAMANTHA HENDERSON (NPI# 1194003392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194003392 |
| Entity Type | Individual |
| Full Name | KELLI SAMANTHA HENDERSON |
| Credential | BA |
| Practice Address |
3407 Shamrock Ct Gautier MS 39553-6429 |
| Practice Telephone | 2284970690 |
| Practice Fax Number | 2284971363 |
| Mailing Telephone | 2284970690 |
| Mailing Fax Number | 2284971363 |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2011-07-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00018214 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326426982 | Kelli Henderson | Counselor | 5500 E Yale Ave Ste 202, Denver, CO 80222-6930 | 2015-05-14 |
| 1275180069 | Kelli Henderson | Student in an Organized Health Care Education/Training Program | 2119 Orchard Ave, Grand Junction, CO 81501-6753 | 2019-08-26 |
| 1720252489 | Kelli Henderson | Registered Nurse | 510 Lincoln Dr, Herrin, IL 62948-6334 | 2008-04-14 |
| 1497961338 | Kelli Henderson | Dentist | 1425 Wakarusa Dr, Suite D, Lawrence, KS 66049-3832 | 2007-05-15 |
| Street Address |
3407 SHAMROCK CT |
| City | GAUTIER |
| State | MS |
| Zip Code | 39553-6429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184626905 | Julie T Trice | Nurse Practitioner | 3407 Shamrock Ct, Gautier, MS 39553 | 2005-08-11 |
| 1144820689 | Erica Lynn Holden | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-10-26 |
| 1588271100 | Kayla Mitchell | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-09-28 |
| 1134733967 | Elizabeth Ann Shepard-bynum | Peer Specialist | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-08-31 |
| 1336751916 | Courtney Dale Trull | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-08-17 |
| 1073138509 | Thomas Gregory Hicks | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-06-10 |
| 1588287148 | Kaitlyn Hinton | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-05-18 |
| 1043832140 | Brenda Gail Miller | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-05-12 |
| 1639716517 | Chiquita Walker | Counselor | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2019-12-10 |
| 1629615505 | Alexusia Jones | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2019-12-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205465044 | Loggan Malone | Dentist | 2808 Us-90 W, Gautier, MS 39553 | 2020-04-03 |
| 1770979775 | Catherine Durham | Counselor | 3407 Shamrock Dr., Gautier, MS 39553 | 2015-04-07 |
| 1851648836 | Pharmatex, LLC | Pharmacy | 4551-d Gautier Vancleave Road, Gautier, MS 39553 | 2012-08-09 |
| 1891957544 | David W Bonderer Dds Pllc | Dentist | 2808 Hwy 90, Suite 1, Gautier, MS 39553 | 2008-06-25 |
| 1790830313 | William D Parrish | Dentist | 713 Us Hwy 90, Gautier, MS 39553 | 2007-01-24 |
| 1073685830 | Jeffrey Lamone Knight | Dentist | 3105 Shaw Dr., Gautier, MS 39553 | 2006-11-15 |
| 1720178437 | Erica B Wilson | Counselor | 3704 Shamrock Court, Gautier, MS 39553 | 2006-10-13 |
| 1881781631 | James D Victory | Chiropractor | 315 Highway 90, Gautier, MS 39553 | 2006-10-05 |
| 1508959180 | Robert Douglas Holbert | Internal Medicine | 2105 Old Spanish Trail, Gautier, MS 39553 | 2006-10-02 |
| 1962508119 | Sentry-gautier, Inc. | Nursing Facility/Intermediate Care Facility | 5090 Gautier Vancleave Road, Gautier, MS 39553 | 2006-09-15 |
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| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245646900 | Jalisa Delinda Mcmillan | Case Manager/Care Coordinator | 407 Shamrock Ct, Gautier, MS 39553-5337 | 2014-07-02 |
| 1144820689 | Erica Lynn Holden | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-10-26 |
| 1588271100 | Kayla Mitchell | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-09-28 |
| 1336751916 | Courtney Dale Trull | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-08-17 |
| 1073138509 | Thomas Gregory Hicks | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-06-10 |
| 1588287148 | Kaitlyn Hinton | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-05-18 |
| 1043832140 | Brenda Gail Miller | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2020-05-12 |
| 1629615505 | Alexusia Jones | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2019-12-10 |
| 1124663125 | Ashley Lauren Tatham | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2019-11-13 |
| 1487296075 | Riyana Marshall | Case Manager/Care Coordinator | 3407 Shamrock Ct, Gautier, MS 39553-5337 | 2019-10-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.