Healthcare Provider Details

I. General information

NPI: 1831142298
Provider Name (Legal Business Name): ALLISON H HENDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 N FLOYD RD STE 8
RICHARDSON TX
75080-4243
US

IV. Provider business mailing address

1112 N FLOYD RD STE 8
RICHARDSON TX
75080-4243
US

V. Phone/Fax

Practice location:
  • Phone: 214-484-8802
  • Fax: 214-484-4146
Mailing address:
  • Phone: 214-484-8802
  • Fax: 214-484-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK9800
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberK9800
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK9800
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: