Healthcare Provider Details

I. General information

NPI: 1821047135
Provider Name (Legal Business Name): MICHELE A HENLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MEADOWVIEW RD SUITE 3
BRISTOL TN
37620-1661
US

IV. Provider business mailing address

999 EXECUTIVE PARK BLVD SUITE 201
KINGSPORT TN
37660-4632
US

V. Phone/Fax

Practice location:
  • Phone: 423-968-2246
  • Fax: 423-968-7223
Mailing address:
  • Phone: 423-224-3250
  • Fax: 423-224-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12006
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: