Provider Demographics
NPI:1356312359
Name:HENNING, AMY ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:HENNING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:RADICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4102 24TH ST STE 506
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1805
Practice Address - Country:US
Practice Address - Phone:806-725-7980
Practice Address - Fax:806-723-7985
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201628207XP3100X, 207X00000X
TXR0412207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX557830YKT8OtherTX MEDICARE
TX8GK818OtherBCBS TX
TX367943301Medicaid