Provider Demographics
NPI:1962257402
Name:HENRY, NICHOLAS ALLEN
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALLEN
Last Name:HENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 MONTAVESTA RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3512
Mailing Address - Country:US
Mailing Address - Phone:606-425-7705
Mailing Address - Fax:
Practice Address - Street 1:3336 MONTAVESTA RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3512
Practice Address - Country:US
Practice Address - Phone:606-425-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program