Provider Demographics
NPI:1023195138
Name:HENDERSON, CHRIS JAMES (CPED-COF)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:JAMES
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:CPED-COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 AUGUSTA DR
Mailing Address - Street 2:SUITE 365
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4922
Mailing Address - Country:US
Mailing Address - Phone:832-251-9083
Mailing Address - Fax:832-251-9064
Practice Address - Street 1:2400 AUGUSTA DR
Practice Address - Street 2:SUITE 365
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4922
Practice Address - Country:US
Practice Address - Phone:832-251-9083
Practice Address - Fax:832-251-9064
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC20115374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1023195138Medicare NSC