Provider Demographics
NPI:1750820296
Name:HENDRICKS, CARRISTON (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CARRISTON
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:FNP-C
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 1749
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-1749
Mailing Address - Country:US
Mailing Address - Phone:936-590-4708
Mailing Address - Fax:936-590-4815
Practice Address - Street 1:1743 SOUTHVIEW CIR
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-9324
Practice Address - Country:US
Practice Address - Phone:936-590-4708
Practice Address - Fax:936-590-4815
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily