Provider Demographics
NPI:1326766213
Name:HENDERSON, ASHLEE MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEE
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E ELDORADO PKWY STE 104B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5999
Mailing Address - Country:US
Mailing Address - Phone:972-987-0458
Mailing Address - Fax:
Practice Address - Street 1:2700 E ELDORADO PKWY STE 104B
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5999
Practice Address - Country:US
Practice Address - Phone:972-987-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF08220561207Q00000X
TX1096491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649682857Medicaid