Healthcare Provider Details

I. General information

NPI: 1962343624
Provider Name (Legal Business Name): CAREY MICHAEL HENSON MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 N PENNGROVE WAY
MERIDIAN ID
83646-7443
US

IV. Provider business mailing address

3245 N WING RD
STAR ID
83669-5146
US

V. Phone/Fax

Practice location:
  • Phone: 208-938-3663
  • Fax: 208-938-3664
Mailing address:
  • Phone: 208-871-5869
  • Fax: 208-871-5869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2581102
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: