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General NPI Number Information
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NPI Number | 1629946215
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Entity Type | Individual
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Provider Name | TYLOR HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 4208 SW GREEN OAKS BLVD
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City | ARLINGTON
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State | TX
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Zip | 76017-4111
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Country | US
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Telephone | 817-483-8368
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Fax | 817-483-6488
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Provider Business Mailing Address
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Address Line | 9305 TRAMMEL DAVIS RD
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City | FORT WORTH
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State | TX
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Zip | 76118-2007
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Country | US
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Telephone | 940-231-0362
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 76496
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License Number State | TX
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