Provider Demographics
NPI:1518502475
Name:HENDERSON, MARISSA LYNNE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNNE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:888-973-8821
Practice Address - Street 1:1201 FANNIN ST STE 262
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-6943
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP003247363L00000X
COC-APN.0103933-C-NP363L00000X
TN38496363L00000X
TXAP143723363L00000X
FLAPRN11037949363L00000X
OR10041652363L00000X
KY4035650363L00000X
WAAP61670672363L00000X
AR232324363L00000X
MS907312363L00000X
PASP032352363L00000X
AL3-002294363L00000X
AZ322525363L00000X
MO2025008125363L00000X
SC30139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGOtherBCBS