Provider Demographics
NPI:1982984779
Name:HENSON CLINIC
Entity Type:Organization
Organization Name:HENSON CLINIC
Other - Org Name:FAMILY FOCUSED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MARCY
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP FNPC
Authorized Official - Phone:972-347-1320
Mailing Address - Street 1:301 N PRESTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8645
Mailing Address - Country:US
Mailing Address - Phone:972-347-1320
Mailing Address - Fax:972-347-1322
Practice Address - Street 1:301 N PRESTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8645
Practice Address - Country:US
Practice Address - Phone:972-347-1320
Practice Address - Fax:972-347-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616839364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288568301Medicaid
TXTXB138272Medicare PIN
TXTXB138273Medicare PIN