Healthcare Provider Details

I. General information

NPI: 1265148910
Provider Name (Legal Business Name): CAS HENDERSON FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N KOBAYASHI STE A
WEBSTER TX
77598-4722
US

IV. Provider business mailing address

PO BOX 58406
WEBSTER TX
77598-8406
US

V. Phone/Fax

Practice location:
  • Phone: 281-724-7341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11024120
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1112626
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number74278
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: