Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | L9852 | TX |
NPI | 1023080769 |
---|---|
Provider Name | Kendi Hensel |
First Address | Fort Worth, TX 76199-0335 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 13/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173316401 | (05) | TX |
8M6411 | BCBS (01) | TX |
I18400 | (02) | TX |
P00273464 | RAILROAD MEDICARE PIN (01) | TX |