Healthcare Provider Details

I. General information

NPI: 1619610151
Provider Name (Legal Business Name): JULIA HENLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ROANE ST
CHARLESTON WV
25302-2334
US

IV. Provider business mailing address

1421 ALEXANDRIA PL
CHARLESTON WV
25314-2502
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0096
  • Fax:
Mailing address:
  • Phone: 304-389-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number116460
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: