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General NPI Number Information
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NPI Number | 1396379525
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Entity Type | Individual
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Provider Name | JEREMY ROBERT HENDRICKSON APRN
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Gender | Male
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 2700 E 29TH ST STE 260
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City | BRYAN
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State | TX
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Zip | 77802-2587
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Country | US
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Telephone | 979-774-0012
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Fax | 979-774-4636
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Provider Business Mailing Address
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Address Line | 2700 E 29TH ST STE 260
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City | BRYAN
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State | TX
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Zip | 77802-2587
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Country | US
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Telephone | 979-821-6300
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Fax | 979-823-4545
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95155222
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 91079
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 844664
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | H158450
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License Number State | IA
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 113125
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License Number State | NE
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP145332
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP145332
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License Number State | TX
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