Provider Demographics
NPI:1952556680
Name:HENSON, AMY SUZANNE (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:HENSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 TEXAS DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6327
Mailing Address - Country:US
Mailing Address - Phone:817-458-3300
Mailing Address - Fax:817-458-3370
Practice Address - Street 1:1517 TEXAS DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6327
Practice Address - Country:US
Practice Address - Phone:817-458-3300
Practice Address - Fax:817-458-3370
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198927901Medicaid
TXP00815324OtherRAILROAD MEDICARE
TX8Y9488OtherBCBS
TX198927903Medicaid
TX8L6399Medicare PIN