Healthcare Provider Details

I. General information

NPI: 1477088730
Provider Name (Legal Business Name): PAUL WILLARD HENLEY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE A120
LEXINGTON KY
40504-3779
US

IV. Provider business mailing address

157 SHELBY COURT
RICHMOND KY
40475
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-6784
  • Fax: 859-258-6796
Mailing address:
  • Phone: 865-255-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57032
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57032
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number57032
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: