Provider Demographics
NPI:1891563706
Name:HENDERSON, LAVORYA B (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:LAVORYA
Middle Name:B
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-2932
Mailing Address - Country:US
Mailing Address - Phone:817-722-4026
Mailing Address - Fax:
Practice Address - Street 1:600 W 6TH ST STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-2849
Practice Address - Country:US
Practice Address - Phone:800-820-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy