Provider Demographics
NPI:1003494238
Name:HENRY, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HENRY
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 1:102 HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:KY
Mailing Address - Zip Code:42234
Mailing Address - Country:US
Mailing Address - Phone:229-234-0062
Mailing Address - Fax:
Practice Address - Street 1:102 HOWELL ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:KY
Practice Address - Zip Code:42234-4223
Practice Address - Country:US
Practice Address - Phone:229-234-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)