Healthcare Provider Details

I. General information

NPI: 1558033027
Provider Name (Legal Business Name): KATRINA KAY HENSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 URBAN CREEK RD
MANCHESTER KY
40962-6003
US

IV. Provider business mailing address

PO BOX 1003
MANCHESTER KY
40962-4003
US

V. Phone/Fax

Practice location:
  • Phone: 606-594-7424
  • Fax:
Mailing address:
  • Phone: 606-594-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3015224
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3015224
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: