Provider Demographics
NPI:1568401909
Name:HARRIS-HENDERSON, KESHA RICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KESHA
Middle Name:RICHELLE
Last Name:HARRIS-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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3555 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3461
Practice Address - Country:US
Practice Address - Phone:972-709-2580
Practice Address - Fax:972-283-9387
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL02512085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105095707Medicaid
TX105095706Medicaid
TX8R1455OtherBLUE CROSS OF TEXAS
TX105095705Medicaid
TX105095707Medicaid
TXTXB112581Medicare PIN
TX8R1455OtherBLUE CROSS OF TEXAS
TX8B1087Medicare PIN
TXP00053514Medicare PIN
TX8D2305Medicare PIN