Provider Demographics
NPI:1225891047
Name:HENDERSON, FELISHA SHAWNTE (APRN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:FELISHA
Middle Name:SHAWNTE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 BARON GATE CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5094
Mailing Address - Country:US
Mailing Address - Phone:832-385-8515
Mailing Address - Fax:
Practice Address - Street 1:8901 EMMETT F LOWRY EXPY STE A
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2279
Practice Address - Country:US
Practice Address - Phone:281-559-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150818363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care