Active NPI
Kelley O Henry, RN
- Registered Nurse
- Charles Town, WV
National Provider Identifier
1336476498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 64165
- Practice address
- 110 Mordington Avenue
Jefferson County Board of Education
Charles Town, WV 25414 - Phone
- (304) 267-3595
- NPI assigned
- Nov 11, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 64165 | WV | Primary |
Addresses
Primary practice location
110 Mordington Avenue
Jefferson County Board of Education
Charles Town, WV 25414
Mailing address
110 Mordington Avenue
Jefferson County Board of Education
Charles Town, WV 25414
Phone (304) 267-3595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810004159 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64165 | WV | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson County Schools | Past | Accepting new patients | |
| Jefferson County Board of Education | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Local Education Agency (LEA)
- Charles Town, WV
- NPI 1750550570
-
- Local Education Agency (LEA)
- Charles Town, WV
- NPI 1639367402
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257897600000",
"number": "1336476498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 MORDINGTON AVENUE",
"address_2": "JEFFERSON COUNTY BOARD OF EDUCATION",
"city": "CHARLES TOWN",
"state": "WV",
"postal_code": "25414",
"telephone_number": "304-267-3595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 MORDINGTON AVENUE",
"address_2": "JEFFERSON COUNTY BOARD OF EDUCATION",
"city": "CHARLES TOWN",
"state": "WV",
"postal_code": "25414",
"telephone_number": "304-267-3595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRY",
"first_name": "KELLEY",
"middle_name": "O",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-11",
"last_updated": "2009-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WV",
"license": "64165",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810004159",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Charles Town, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.