Provider Demographics
NPI:1841817772
Name:HENRY, KELSEY RHAE WILLIAMS (MD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:RHAE WILLIAMS
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-383-1002
Mailing Address - Fax:904-244-5965
Practice Address - Street 1:655 W 8TH ST FL CENTER4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-383-1002
Practice Address - Fax:904-244-5965
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN31496207Q00000X
FLME155672390200000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program