Healthcare Provider Details

I. General information

NPI: 1750296380
Provider Name (Legal Business Name): INTO THE OUT MOBILE PEDIATRIC WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HICKORY RIDGE ESTATES RD
COLDIRON KY
40819
US

IV. Provider business mailing address

PO BOX 50
HARLAN KY
40831-0050
US

V. Phone/Fax

Practice location:
  • Phone: 606-562-5212
  • Fax:
Mailing address:
  • Phone: 606-562-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REBECCA ANN HENSLEY
Title or Position: MEMBER/ MANAGING MEMBER
Credential: APRN
Phone: 606-562-5212