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General NPI Number Information
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NPI Number | 1205060415
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Entity Type | Individual
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Provider Name | KELLEY MARIE HENSON N.P.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 224 W D. L. INGRAM AVENUE BLDG. 1408
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone | 757-225-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 224 W D. L. INGRAM AVENUE BLDG. 1408
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone | 757-902-7154
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APN13239
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0024169514
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License Number State | VA
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