MEDICARE: WEDNESDAY M HENRY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	160666	AK
2	363LF0000X	Family Nurse Practitioner	643131	TX
3	363LF0000X	Family Nurse Practitioner	AP113678	TX

General Provider Information

NPI Number	:	1467434233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WEDNESDAY M HENRY NP

Provider Business Mailing Address
First Line	:	1202 FM 3036
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-7798
Country	:	US
Telephone Number	:	361-729-0133
Fax Number	:	361-729-0855

Provider Business Practice Location Address
First Line	:	1202 FM 3036
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-7798
Country	:	US
Telephone Number	:	361-729-0133
Fax Number	:	361-729-0855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	01/23/2024

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