Provider Demographics
NPI:1467778084
Name:HENDERSON, CARLA GEAN (RN, MSN, GNP)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:GEAN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN, MSN, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-7649
Mailing Address - Country:US
Mailing Address - Phone:409-772-8652
Mailing Address - Fax:409-772-6830
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-7649
Practice Address - Country:US
Practice Address - Phone:409-772-8652
Practice Address - Fax:409-772-6830
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601127363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology