Provider Demographics
NPI:1831864289
Name:HENNING FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:HENNING FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:270-580-4050
Mailing Address - Street 1:124 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2624
Mailing Address - Country:US
Mailing Address - Phone:270-580-4050
Mailing Address - Fax:270-580-4051
Practice Address - Street 1:124 W 3RD ST
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2624
Practice Address - Country:US
Practice Address - Phone:270-580-4050
Practice Address - Fax:270-580-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134513559OtherINDIVIDUAL NPI
KY7100405900Medicaid