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General NPI Number Information
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NPI Number | 1457380990
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Entity Type | Individual
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Provider Name | TERESA LYNN HENDERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 E 10TH ST
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City | ANNISTON
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State | AL
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Zip | 36207-4716
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Country | US
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Telephone | 256-235-5121
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Fax |
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Provider Business Mailing Address
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Address Line | 14050 NW 14TH ST SUITE 190
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City | SUNRISE
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State | FL
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Zip | 33323-2865
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Country | US
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Telephone | 800-424-3672
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Fax | 954-377-3042
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-20
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License Number State | AL
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