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Organization
LECELT, INC
Active
Organization
LECELT, INC
Active
Other names
Henrikson Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JEAN LYNN HENRIKSON FNP (OWNER)
(325) 703-6670
Entity
Organization
Contact information
Practice address
2133 OFFICE PARK DR STE A, SAN ANGELO, TX 76904-6803
(325) 703-6670
(325) 703-6672
Mailing address
3371 KNICKERBOCKER RD, # 236, SAN ANGELO, TX 76904-6814
(325) 703-6670
(325) 703-6672
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164744807
—
TX
Enumeration date
05/03/2017
Last updated
05/20/2021
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