MEDICARE: WELDON S HENDERSON CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R0025031	OK
2	367500000X	Certified Registered Nurse Anesthetist	535862	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	89953U	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1447275961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WELDON S HENDERSON CRNA

Provider Business Mailing Address
First Line	:	419 W GRAY ST
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73069-7117
Country	:	US
Telephone Number	:	405-809-4200
Fax Number	:	405-364-5379

Provider Business Practice Location Address
First Line	:	4750 N EXPRESSWAY
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-4120
Country	:	US
Telephone Number	:	956-554-2014
Fax Number	:	956-554-2001

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	01/05/2012

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Directions to “ WELDON S HENDERSON CRNA” Practice Location

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