Healthcare Provider Details

I. General information

NPI: 1255936167
Provider Name (Legal Business Name): SHAMEEKA S HENRY CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 06/16/2024
Certification Date: 06/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8347 CAMP BOWIE WEST BLVD
FT WORTH TX
76116-6331
US

IV. Provider business mailing address

2885 MABE RD APT 1608A
SAN ANTONIO TX
78251-1574
US

V. Phone/Fax

Practice location:
  • Phone: 817-879-9283
  • Fax:
Mailing address:
  • Phone: 817-719-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number14560
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10074153
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: