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General NPI Number Information
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NPI Number | 1720668650
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Entity Type | Individual
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Provider Name | KELSEY HENEBERRY
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Gender | Female
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 10/12/2024
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Provider Practice Location Address
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Address Line | 2222 CHERRY ST STE 1250
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City | TOLEDO
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State | OH
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Zip | 43608-2687
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Country | US
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Telephone | 419-251-3180
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Fax | 419-251-3849
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Provider Business Mailing Address
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Address Line | 2222 CHERRY ST STE 1250
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City | TOLEDO
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State | OH
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Zip | 43608-2687
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Country | US
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Telephone |
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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 | APRN.CNP.0028167
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209021951
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN.CNP.0028167
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209021951
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License Number State | IL
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