Provider Demographics
NPI:1730147869
Name:HENLY, NANCY J (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:HENLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:234 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1194
Mailing Address - Country:US
Mailing Address - Phone:606-780-5330
Mailing Address - Fax:606-780-2373
Practice Address - Street 1:716 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1444
Practice Address - Country:US
Practice Address - Phone:606-780-5364
Practice Address - Fax:606-780-2380
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64241854Medicaid
KY24185OtherLICENSE
KY64241854Medicaid