Provider Demographics
NPI:1306622865
Name:HENDREN, AUSTIN TAYLOR
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:TAYLOR
Last Name:HENDREN
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 1:135 EAGLES NEST CIR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-9666
Mailing Address - Country:US
Mailing Address - Phone:208-995-7606
Mailing Address - Fax:
Practice Address - Street 1:3409 WORTH ST STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2042
Practice Address - Country:US
Practice Address - Phone:469-800-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant