=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598998643
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA HELEN HENDRIX RN, BSM, MS, PHD, CN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2009
-----------------------------------------------------
Last Update Date | 08/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5310 COUNTY ROAD 200
-----------------------------------------------------
City | LIBERTY HILL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78642-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-778-9393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CARL R. DARNALL ARMY MEDICAL CENTER DARNALL LOOP
-----------------------------------------------------
City | FORT HOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-286-7500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | AP30005840
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------