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General NPI Number Information
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NPI Number | 1295748408
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Entity Type | Individual
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Provider Name | KENNETH ROY HENRY P.A.-C.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 3939 CENTRAL PIKE
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City | HERMITAGE
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State | TN
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Zip | 37076-3499
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Country | US
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Telephone | 615-883-2331
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Fax |
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Provider Business Mailing Address
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Address Line | 115 NEW HALLTOWN RD
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City | HARTSVILLE
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State | TN
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Zip | 37074-1929
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Country | US
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Telephone | 615-374-0006
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 749
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License Number State | TN
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