Provider Demographics
NPI:1336917426
Name:HENSON, ERIN JO
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JO
Last Name:HENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:JO
Other - Last Name:COFFEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:612 MCCLURE AVE
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-8933
Mailing Address - Country:US
Mailing Address - Phone:918-340-8967
Mailing Address - Fax:
Practice Address - Street 1:612 MCCLURE AVE
Practice Address - Street 2:
Practice Address - City:HULBERT
Practice Address - State:OK
Practice Address - Zip Code:74441-8933
Practice Address - Country:US
Practice Address - Phone:918-340-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist