Provider Demographics
NPI:1033999727
Name:HENSON, KATHY JO (RN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JO
Last Name:HENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:JO
Other - Last Name:LEBEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4240 E 119TH PL APT E
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-6307
Mailing Address - Country:US
Mailing Address - Phone:803-542-0342
Mailing Address - Fax:
Practice Address - Street 1:14300 ORCHARD PKWY
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9206
Practice Address - Country:US
Practice Address - Phone:720-627-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1653467163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse