MEDICARE: BRANDY LEMETRIA HENDERSON COSMETOLOGIST

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	224P00000X	Prosthetist	1570662	TX

General Provider Information

NPI Number	:	1871424440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY LEMETRIA HENDERSON COSMETOLOGIST

Provider Business Mailing Address
First Line	:	1229 E PLEASANT RUN RD
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-4209
Country	:	US
Telephone Number	:	469-799-7306
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 E PLEASANT RUN RD
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-4209
Country	:	US
Telephone Number	:	469-799-7306
Fax Number	:

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

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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