Healthcare Provider Details

I. General information

NPI: 1669395760
Provider Name (Legal Business Name): LUCAS ERIK HENLEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 WOODS STREAM LN
ASHEBORO NC
27205-8191
US

IV. Provider business mailing address

2180 WOODS STREAM LN
ASHEBORO NC
27205-8191
US

V. Phone/Fax

Practice location:
  • Phone: 336-963-8953
  • Fax:
Mailing address:
  • Phone: 336-963-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number381334
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: