Healthcare Provider Details

I. General information

NPI: 1063917011
Provider Name (Legal Business Name): MIRIAM LOUISE HENRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LONDON MOUNTAIN VIEW DR
LONDON KY
40741-6601
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-0770
  • Fax: 606-864-1461
Mailing address:
  • Phone: 606-330-7835
  • Fax: 606-864-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number59386
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number59386
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: