Healthcare Provider Details

I. General information

NPI: 1073306437
Provider Name (Legal Business Name): KATHERINE REBECCA HENRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JOHN F KENNEDY DR
ATLANTIS FL
33462-1119
US

IV. Provider business mailing address

101 JOHN F KENNEDY DR
ATLANTIS FL
33462-1119
US

V. Phone/Fax

Practice location:
  • Phone: 561-612-8080
  • Fax:
Mailing address:
  • Phone: 561-612-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11039760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: