Provider Demographics
NPI:1063612331
Name:HENDON, YOLANDA
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:HENDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3981
Mailing Address - Country:US
Mailing Address - Phone:972-515-8700
Mailing Address - Fax:469-218-0682
Practice Address - Street 1:106 PLAZA DR
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3981
Practice Address - Country:US
Practice Address - Phone:972-515-8700
Practice Address - Fax:469-218-0682
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228832364SF0001X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170991703Medicaid
TX170991702Medicaid
TXD07564OtherMEDICARE TX RR PALMETTO
TXDQ5280OtherMEDICARE RR PALMETTO
TX8K6147Medicare UPIN
TX170991703Medicaid
TX170991702Medicaid
TXD07564OtherMEDICARE TX RR PALMETTO