MEDICARE: PORSHA HENDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1154167484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORSHA HENDERSON

Provider Business Mailing Address
First Line	:	10115 HEDGE WAY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4165
Country	:	US
Telephone Number	:	832-983-0253
Fax Number	:

Provider Business Practice Location Address
First Line	:	10115 HEDGE WAY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4165
Country	:	US
Telephone Number	:	832-983-0253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/05/2024

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Directions to “ PORSHA HENDERSON ” Practice Location

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