Provider Demographics
NPI:1487795431
Name:HENLEY, KATHRYN V (CRNA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:V
Last Name:HENLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:V
Other - Last Name:SLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:975 E. THIRD STREET
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7608
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN133614163W00000X
TNAPN11305367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939025Medicaid
TN3633373Medicaid
NC8052085Medicaid
GAN366438OtherWELLCARE (GA MEDICAID)
4068611OtherBCBS OF TN
GA833853830AMedicaid
P00128490OtherRR MEDICARE
NC8052085Medicaid
AL009939025Medicaid