Provider Demographics
NPI:1629298583
Name:HENRY, ROBERT CARL (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CARL
Last Name:HENRY
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:876 FOX HUNT TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-2354
Mailing Address - Country:US
Mailing Address - Phone:682-286-0293
Mailing Address - Fax:
Practice Address - Street 1:4351 BOOTH CALLOWAY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7378
Practice Address - Country:US
Practice Address - Phone:817-284-1165
Practice Address - Fax:817-284-3268
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant