Healthcare Provider Details

I. General information

NPI: 1871411587
Provider Name (Legal Business Name): ROBERT NELSON HENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 WOODRUFF ST
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

1121 SHELL DR APT 25
SPRING LAKE NC
28390-2049
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-7673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: