| Provider / Organization | NPI | Date Certified |
|---|---|---|
| RAVEN HENDERSON | 1437415726 | 2024-07-05 |
Raven C Henderson [F] graduated in 2008 from University Of Texas Medical School At Houston and primarily specializes in Plastic And Reconstructive Surgery.
Raven Henderson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1437415726. Registration indicates Raven Henderson is a provider of services with a specialization in Allopathic & Osteopathic Physicians, Plastic Surgery (Plastic Surgery, ) (Specialist Network, ) (Plastic Surgery, Allopathic & Osteopathic Physicians)
| PECOS ID | 5799933842 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Raven Henderson M.D. |
| Practice Office Address | 2140 W GRANDE BLVD STE A TYLER, TX US |
| Practice Office Telephone | 9032512765 |
| Practice Office Fax | 2702166827 |
| Mailing Address | 2140 W GRANDE BLVD STE A TYLER, TX 757030563 US |
| Business Telephone | 9032512765 |
| Business Fax | 2702166827 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 8919 Parallel Pkwy Ste 270 | Kansas City, KS 661121655 | 9133346800 / 9133340875 |
| 3550 S 4th St Ste 115 | Leavenworth, KS 660485061 | 9133346800 / 9133340875 |
| 4128 Doolittle Dr | Lawrence, KS 660494117 | 3477468779 |
| Code | Practice | License No State |
|---|---|---|
| 208200000X PRIMARY | Allopathic & Osteopathic Physicians Plastic Surgery Plastic Surgery Specialist Network Plastic Surgery Allopathic & Osteopathic Physicians | 04-40363
KS |