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General NPI Number Information
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NPI Number | 1255936167
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Entity Type | Individual
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Provider Name | SHAMEEKA S HENRY CHW
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 06/16/2024
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Provider Practice Location Address
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Address Line | 8347 CAMP BOWIE WEST BLVD
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City | FT WORTH
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State | TX
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Zip | 76116-6331
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Country | US
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Telephone | 817-879-9283
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Fax |
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Provider Business Mailing Address
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Address Line | 2885 MABE RD APT 1608A
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City | SAN ANTONIO
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State | TX
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Zip | 78251-1574
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Country | US
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Telephone | 817-719-7580
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Fax |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 14560
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 10074153
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License Number State | TX
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