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General NPI Number Information
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NPI Number | 1073306437
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Entity Type | Individual
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Provider Name | KATHERINE REBECCA HENRY FNP
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Gender | Female
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 101 JOHN F KENNEDY DR
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City | ATLANTIS
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State | FL
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Zip | 33462-1119
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Country | US
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Telephone | 561-612-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 101 JOHN F KENNEDY DR
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City | ATLANTIS
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State | FL
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Zip | 33462-1119
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Country | US
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Telephone | 561-612-8084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11039760
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License Number State | FL
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