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NPI Code Detail

MEDICARE: KELLY STEVENS HENDERSON APRN

MEDICARE: KELLY STEVENS HENDERSON APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerF03210342NC
2363LF0000XFamily Nurse PractitionerF03210342NC

General Provider Information

NPI Number : 1518548528
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY STEVENS HENDERSON APRN
Provider Business Mailing Address
First Line : 10 ELBERT BURNETT RD
Second Line :
City : CANTON
State : NC
Zip : 28716-6401
Country : US
Telephone Number : 828-246-4650
Fax Number :
Provider Business Practice Location Address
First Line : 1 SAINT DUNSTANS RD STE 100
Second Line :
City : ASHEVILLE
State : NC
Zip : 28803-2791
Country : US
Telephone Number : 828-252-4020
Fax Number : 828-252-4022
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2021
Last Update Date : 04/20/2021

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