John M Henderson MD Fapa, PLLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

D4150 Issued in TX

Legal business name

JOHN M HENDERSON MD FAPA, PLLC

Practice address

716 S Koenigheim St
San Angelo, TX 76903-6770

Phone

(443) 829-5805

NPI assigned

Oct 22, 2013

Organization subpart

No

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

Authorized official

Name

Dr. John M Henderson

Title

Provider

Phone

(325) 617-7913

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395100800000",
    "number": "1164850657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 S KOENIGHEIM ST",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769036770",
            "telephone_number": "325-617-7913",
            "fax_number": "325-617-7917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 S KOENIGHEIM ST",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769036770",
            "telephone_number": "443-829-5805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN M HENDERSON MD FAPA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-22",
        "last_updated": "2014-03-18",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "325-617-7913",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "TX",
            "license": "D4150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX MEDICAL LICENSE",
            "identifier": "D4150",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jim W. Collier, Dcpa (Southwest Back Clinic)
• Lydia J Jimenez, MS
• Havalo Kaye Jo Hanson, P.T.
• Joe M Jeffers (West Texas Psychological Associates)
• John D. Hunt, M.D.
• Amanda C. John, APRN-FNP
• Glenda Johnson, LVN
• Karren Johnson, LCSW
• Kavin Wood Johnson, M.S., L.P.C.
• Ryan Johnson, LAT, ATC

• Clinical Neuropsychologist in San Angelo, TX
• Providers in San Angelo, TX by specialty
• Clinical Neuropsychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; 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.