Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | AP129290 | TX |
Y | 208000000X | Pediatrician | AP60724707 | WA |
N | 363L00000X | Nurse Practitioner | AP60724707 | WA |
N | 363LN0000X | Nurse Practitioner - Neonatal | AP60724707 | WA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP60724707 | WA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | AP60724707 | WA |
N | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | AP60724707 | WA |
NPI | 1316318157 |
---|---|
Provider Name | Brandy N Henson |
First Address | Longview, TX 75601 |
Second Address | Longview, TX 75601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2015 |
Last Update Date | 20/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2074713 | (05) | WA |
214655758 | (05) | AR |