Provider Demographics
NPI:1124851548
Name:HENDRY, KENNETH RAY (RN)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:HENDRY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11998 SWANSEA DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3622
Mailing Address - Country:US
Mailing Address - Phone:303-889-9649
Mailing Address - Fax:
Practice Address - Street 1:11998 SWANSEA DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3622
Practice Address - Country:US
Practice Address - Phone:303-889-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0096527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse