MEDICARE: LAVORYA B HENDERSON PHLEBOTOMIST

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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1891563706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVORYA B HENDERSON PHLEBOTOMIST

Provider Business Mailing Address
First Line	:	6659 SHERIDAN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-2932
Country	:	US
Telephone Number	:	817-722-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W 6TH ST STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-2849
Country	:	US
Telephone Number	:	800-820-8210
Fax Number	:

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

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	12/20/2023

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