Provider Demographics
NPI:1548208895
Name:HENDERSON, KIMBERLY L (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:713-659-2666
Mailing Address - Fax:713-659-8930
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 1003
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-659-2666
Practice Address - Fax:713-659-8930
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2600207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF37284Medicare UPIN
TX8F2440Medicare PIN