Provider Demographics
NPI:1629362645
Name:HENRY, ELIZABETH ANN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:HENRY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12103 STATE ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:LAKE LOTAWANA
Mailing Address - State:MO
Mailing Address - Zip Code:64086-9165
Mailing Address - Country:US
Mailing Address - Phone:816-853-3077
Mailing Address - Fax:913-573-7001
Practice Address - Street 1:3201 FAIRFAX TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66115-1307
Practice Address - Country:US
Practice Address - Phone:913-573-7053
Practice Address - Fax:913-573-7001
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011017381363LA2200X
KS53-75912-101363LX0106X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200877280CMedicaid
MO1629362645Medicaid
MO1629362645Medicaid
MOMA462003Medicare PIN