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General NPI Number Information
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NPI Number | 1699014746
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Entity Type | Individual
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Provider Name | DEWANNA HENDERSON PA-C, BA
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Gender | Female
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Dates
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Enumeration Date | 02/10/2013
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 305 S BENEDICT AVE
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City | OAK RIDGE
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State | TN
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Zip | 37830-7310
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Country | US
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Telephone | 865-685-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 5729 LEBANON RD STE 144-425
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City | FRISCO
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State | TX
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Zip | 75034-7260
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2315
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7034
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License Number State | GA
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