Provider Demographics
NPI:1760034870
Name:HENDERSON, JASMONAIYE M
Entity Type:Individual
Prefix:
First Name:JASMONAIYE
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 HIGHWAY 365 APT 204
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7574
Mailing Address - Country:US
Mailing Address - Phone:409-460-8299
Mailing Address - Fax:
Practice Address - Street 1:4180 HIGHWAY 365 APT 204
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7574
Practice Address - Country:US
Practice Address - Phone:409-460-8299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide