Provider Demographics
NPI:1467012120
Name:HENRY, KEITH (ARNP-FNP)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:ARNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 PLANK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-5207
Mailing Address - Country:US
Mailing Address - Phone:540-785-3448
Mailing Address - Fax:
Practice Address - Street 1:5825 PLANK RD STE 105
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-5207
Practice Address - Country:US
Practice Address - Phone:540-785-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0024177706208000000X
VA0024177706208000000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208000000XAllopathic & Osteopathic PhysiciansPediatrics