Individual provider · NPI-1

Raven Henderson, M.D.

Plastic Surgery · Tyler, TX

NPI number1437415726
StatusActive
Last updated in NPPESNov 6, 2026

Details

NPI
1437415726
Entity type
Individual (NPI-1)
Name
Raven Henderson
Credential
M.D.
Sex
Female
Sole proprietor
No
Enumeration date
Apr 11, 2012
Certification date
Nov 6, 2026
Last updated
Nov 6, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208200000X Plastic SurgeryT9922TXYes

Practice location

2140 W Grande Blvd Ste A
Tyler, TX 75703-0563

Phone 903-251-2765 · Fax 270-216-6827

Mailing address

2140 W Grande Blvd Ste A
Tyler, TX 75703-0563

Phone 903-251-2765 · Fax 270-216-6827

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