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General NPI Number Information
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NPI Number | 1043658677
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Entity Type | Individual
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Provider Name | BENNETT ELLEN HARGROVE HENDERSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 4102 24TH ST STE 406
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City | LUBBOCK
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State | TX
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Zip | 79410-1804
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Country | US
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Telephone | 806-725-5790
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Fax | 806-725-5791
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Provider Business Mailing Address
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Address Line | 2215 NASHVILLE AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-1105
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Country | US
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Telephone | 806-725-5844
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Fax | 806-723-6532
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | Q9635
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License Number State | TX
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