Individual
KYLE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1602 ROCK PRAIRIE RD, COLLEGE STATION, TX 77845-8306
(979) 696-4440
(979) 694-8500
Mailing address
PO BOX 3068, BRYAN, TX 77805-3068
(979) 696-4440
(979) 694-8500
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
H8121
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111955404
—
TX
Enumeration date
06/08/2006
Last updated
05/21/2010
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