Provider Demographics
NPI:1063981074
Name:HENDERSON, MAEGAN DANIELLE (FNP)
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:DANIELLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W RENNER RD APT 3816
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1050
Mailing Address - Country:US
Mailing Address - Phone:214-603-2191
Mailing Address - Fax:
Practice Address - Street 1:800 W RENNER RD APT 3816
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1050
Practice Address - Country:US
Practice Address - Phone:214-603-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX773972163W00000X
TXAP139953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty