Provider Demographics
NPI:1144921172
Name:HENLEY, KIMBERLY LOUANN (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOUANN
Last Name:HENLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W END AVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1725
Mailing Address - Country:US
Mailing Address - Phone:615-504-7825
Mailing Address - Fax:615-441-3399
Practice Address - Street 1:301 W END AVE
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1725
Practice Address - Country:US
Practice Address - Phone:615-504-7825
Practice Address - Fax:615-441-3399
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000238225163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health