Provider Demographics
NPI:1932281276
Name:HENRY, KEVIN ROBERT (DPM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROBERT
Last Name:HENRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6425 OLD PLANK RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3277
Mailing Address - Country:US
Mailing Address - Phone:336-882-2070
Mailing Address - Fax:336-882-2074
Practice Address - Street 1:6425 OLD PLANK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3277
Practice Address - Country:US
Practice Address - Phone:336-882-2070
Practice Address - Fax:336-882-2074
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC334213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08073OtherBCBS
NC5846058OtherAETNA
NC7908073Medicaid
NC1761781001OtherCIGNA
NC248565OtherMAMSI
NC27-02398OtherUNITED HEALTHCARE
NC9064OtherPARTNERS
NC7908073Medicaid
NC9064OtherPARTNERS