Provider Demographics
NPI:1518599646
Name:HENRY, TROY (APRN)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 803886
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-3886
Mailing Address - Country:US
Mailing Address - Phone:816-307-4893
Mailing Address - Fax:
Practice Address - Street 1:707 VICTORY LN
Practice Address - Street 2:
Practice Address - City:CAINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64632-9506
Practice Address - Country:US
Practice Address - Phone:660-893-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA157851363L00000X
MO2020034567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA157851Medicaid