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General NPI Number Information
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NPI Number | 1568982635
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Entity Type | Individual
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Provider Name | TRACEY LYNETTE CAMPBELL HENDERSON RN
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 10000 N 31ST AVE STE C262
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City | PHOENIX
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State | AZ
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Zip | 85051-9630
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Country | US
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Telephone | 602-754-0400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 630164
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City | NACOGDOCHES
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State | TX
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Zip | 75963-0164
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Country | US
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Telephone | 936-205-1875
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 1214661
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License Number State | TX
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