Provider Demographics
NPI:1255936167
Name:HENRY, SHAMEEKA S (CHW)
Entity type:Individual
Prefix:
First Name:SHAMEEKA
Middle Name:S
Last Name:HENRY
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 MABE RD APT 1608A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1574
Mailing Address - Country:US
Mailing Address - Phone:817-719-7580
Mailing Address - Fax:
Practice Address - Street 1:8347 CAMP BOWIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6331
Practice Address - Country:US
Practice Address - Phone:817-879-9283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14560172V00000X
TX10074153376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172V00000XOther Service ProvidersCommunity Health Worker