Provider Demographics
NPI:1942710512
Name:HENSON, KAYLEIGH A
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:A
Last Name:HENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8527 VALLEY FARM RD
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:IN
Mailing Address - Zip Code:46058-9802
Mailing Address - Country:US
Mailing Address - Phone:765-430-3263
Mailing Address - Fax:
Practice Address - Street 1:8527 VALLEY FARM RD
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:IN
Practice Address - Zip Code:46058-9802
Practice Address - Country:US
Practice Address - Phone:765-430-3263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007570A363LF0000X
IN28203292A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300008725Medicaid
INM47140310OtherMEDICARE PTAN