Healthcare Provider Details

I. General information

NPI: 1518599646
Provider Name (Legal Business Name): TROY HENRY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 VICTORY LN
CAINSVILLE MO
64632-9506
US

IV. Provider business mailing address

PO BOX 803886
KANSAS CITY MO
64180-3886
US

V. Phone/Fax

Practice location:
  • Phone: 660-893-5750
  • Fax:
Mailing address:
  • Phone: 816-307-4893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA157851
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020034567
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: