Individual
MRS. CHERYL LYNN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
20208 STATE HIGHWAY 155 S, FLINT, TX 75762-5600
(903) 825-6222
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
618206
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142475605
—
TX
01
—
75-2616977-001
TRICARE- CANTON
TX
01
—
75-2616977-028
TRICARE LINDALE
TX
01
—
834N61
BCBS
TX
01
—
P00911377
MEDICARE RAILROAD
TX
01
—
TIN PLUS 002
TRICARE LAKE PALESTINE LOCATION
TX
Enumeration date
11/04/2005
Last updated
02/19/2015
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