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NPI Code Detail

MEDICARE: TARA LANETTE HENLEY LPN

MEDICARE: TARA LANETTE HENLEY LPN
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
1164W00000XLicensed Practical NurseLPN097117GA

General Provider Information

NPI Number : 1861327447
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA LANETTE HENLEY LPN
Provider Business Mailing Address
First Line : 842 GRAYSVILLE RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-4322
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3575 KEITH ST NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-4324
Country : US
Telephone Number : 833-979-0356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

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Directions to “ TARA LANETTE HENLEY LPN” Practice Location

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