Provider Demographics
NPI:1912208638
Name:HENDERSON, KATHERINE YVETTE
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:YVETTE
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 1:1001 ROSS AVE APT 225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-1939
Mailing Address - Country:US
Mailing Address - Phone:214-986-1162
Mailing Address - Fax:
Practice Address - Street 1:1001 ROSS AVE
Practice Address - Street 2:225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-6753
Practice Address - Country:US
Practice Address - Phone:214-986-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator