Provider Demographics
NPI:1598988677
Name:HENRY, PAULA MICHELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MICHELLE
Last Name:HENRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 AMELIA DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-4975
Mailing Address - Country:US
Mailing Address - Phone:937-572-8410
Mailing Address - Fax:
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR STE 260
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4097
Practice Address - Country:US
Practice Address - Phone:937-435-9013
Practice Address - Fax:937-435-1458
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily