Individual provider Active NPI

Wanda Jeraldean Henson, RN

  • Psychiatric/Mental Health Registered Nurse
  • Hobbs, NM
National Provider Identifier
1043458961
Registry record updated Jan 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
License
R35092 Issued in NM
Practice address
920 W Broadway St
Hobbs, NM 88240-5529
Phone
(575) 393-3168
Fax
(575) 397-4659
NPI assigned
Jan 30, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X R35092 NM Primary

Addresses

Primary practice location

920 W Broadway St
Hobbs, NM 88240-5529

Mailing address

920 W Broadway St
Hobbs, NM 88240-5529
Phone (575) 393-3168

Other identifiers 1

IdentifierTypeStateIssuer
463000MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R35092NMMDPsychiatric/Mental Health Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233273600000",
    "number": "1043458961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 W BROADWAY ST",
            "city": "HOBBS",
            "state": "NM",
            "postal_code": "882405529",
            "telephone_number": "575-393-3168",
            "fax_number": "575-397-4659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 W BROADWAY ST",
            "city": "HOBBS",
            "state": "NM",
            "postal_code": "882405529",
            "telephone_number": "575-393-3168",
            "fax_number": "575-397-4659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENSON",
        "first_name": "WANDA",
        "middle_name": "JERALDEAN",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2009-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NM",
            "license": "R35092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463000",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hobbs, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.