Provider Demographics
NPI:1932280070
Name:HENDERSON, TRUDIE (WHNP)
Entity Type:Individual
Prefix:
First Name:TRUDIE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:WHNP
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 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:817-927-1065
Mailing Address - Fax:817-927-1162
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-920-0700
Practice Address - Fax:817-626-8952
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX558812363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156154002Medicaid
TXP00635653OtherRAILROAD MEDICARE
TX8N8823OtherBCBS
TX8L6861Medicare PIN
TX8N8823OtherBCBS