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General NPI Number Information
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NPI Number | 1912724824
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Entity Type | Individual
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Provider Name | LEIGHTON HENDERSON APRN, AGCNS-BC
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Gender | Male
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 506 W WINDCREST ST STE 300
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4639
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Country | US
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Telephone | 830-990-0255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 911230
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City | DALLAS
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State | TX
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Zip | 75391-1230
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Country | US
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Telephone | 972-997-8000
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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 | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 1085229
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 364SX0200X
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Taxonomy Name | Oncology Clinical Nurse Specialist
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License Number | 1085229
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License Number State | TX
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