1063612331 NPI number — YOLANDA HENDON

Table of content: YOLANDA HENDON (NPI 1063612331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063612331 NPI number — YOLANDA HENDON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDON
Provider First Name:
YOLANDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063612331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 PLAZA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED OAK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75154-3981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-515-8700
Provider Business Mailing Address Fax Number:
469-218-0682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED OAK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75154-3981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-515-8700
Provider Business Practice Location Address Fax Number:
469-218-0682
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SF0001X , with the licence number:  228832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 228832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 170991703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170991702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: D07564 . This is a "MEDICARE TX RR PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DQ5280 . This is a "MEDICARE RR PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com