Provider Demographics
NPI:1467434233
Name:HENRY, WEDNESDAY M (NP)
Entity Type:Individual
Prefix:
First Name:WEDNESDAY
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 FM 3036
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-7798
Mailing Address - Country:US
Mailing Address - Phone:361-729-0133
Mailing Address - Fax:361-729-0855
Practice Address - Street 1:1202 FM 3036
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-7798
Practice Address - Country:US
Practice Address - Phone:361-729-0133
Practice Address - Fax:361-729-0855
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK160666363L00000X
TX643131363LF0000X
TXAP113678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G0831Medicare PIN
TXQ54504Medicare UPIN
TXQ54504Medicare UPIN