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NPI Code Detail

MEDICARE: COREY WAYNE HENRY NP

MEDICARE: COREY WAYNE HENRY NP
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
1163W00000XRegistered Nurse653891TX
2363L00000XNurse PractitionerAP135257TX
3363LG0600XGerontology Nurse PractitionerAP135257TX

General Provider Information

NPI Number : 1356403075
Entity Type Code : Individual
Provider Name (Legal Business Name) : COREY WAYNE HENRY NP
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-8800
Fax Number : 254-724-7603
Provider Business Practice Location Address
First Line : 11251 FONDREN RD
Second Line :
City : HOUSTON
State : TX
Zip : 77096-5507
Country : US
Telephone Number : 281-707-7362
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2006
Last Update Date : 08/18/2023

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