Provider Demographics
NPI:1881200392
Name:HENRY-MORRIS, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:HENRY-MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 BAIRSFORD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3012
Mailing Address - Country:US
Mailing Address - Phone:614-367-6535
Mailing Address - Fax:614-367-6535
Practice Address - Street 1:1962 BAIRSFORD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3012
Practice Address - Country:US
Practice Address - Phone:614-367-6535
Practice Address - Fax:614-367-6535
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2788014Medicaid