Provider Demographics
NPI:1992940522
Name:HENGLER, KELLY JEANNE (PA)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JEANNE
Last Name:HENGLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 FAIRVIEW DR STE F
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1250
Mailing Address - Country:US
Mailing Address - Phone:757-562-4196
Mailing Address - Fax:
Practice Address - Street 1:118 FAIRVIEW DR STE F
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851
Practice Address - Country:US
Practice Address - Phone:757-562-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004802207Q00000X, 207R00000X
VA0110-004802363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine