Healthcare Provider Details

I. General information

NPI: 1447275961
Provider Name (Legal Business Name): WELDON S HENDERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 N EXPRESSWAY
BROWNSVILLE TX
78526-4120
US

IV. Provider business mailing address

419 W GRAY ST
NORMAN OK
73069-7117
US

V. Phone/Fax

Practice location:
  • Phone: 956-554-2014
  • Fax: 956-554-2001
Mailing address:
  • Phone: 405-809-4200
  • Fax: 405-364-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0025031
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number535862
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: