Provider Demographics
NPI:1265148910
Name:HENDERSON, CAS (FNP-C)
Entity type:Individual
Prefix:
First Name:CAS
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8648 NORTHRIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7516
Mailing Address - Country:US
Mailing Address - Phone:850-376-6077
Mailing Address - Fax:
Practice Address - Street 1:2438 MONARCH DR STE A-375
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6605
Practice Address - Country:US
Practice Address - Phone:956-523-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112626363LF0000X
NM74278363LF0000X
FL11024120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily