Provider Demographics
NPI:1649953258
Name:HENRY, KEGAN F
Entity type:Individual
Prefix:
First Name:KEGAN
Middle Name:F
Last Name:HENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 JENNINGS RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-8114
Mailing Address - Country:US
Mailing Address - Phone:337-692-3392
Mailing Address - Fax:
Practice Address - Street 1:1244 JENNINGS RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-8114
Practice Address - Country:US
Practice Address - Phone:337-692-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)