Individual provider Active NPI

Kelley O Henry, RN

  • Registered Nurse
  • Charles Town, WV
National Provider Identifier
1336476498
Registry record updated Nov 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
64165 Issued in WV
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

Updated by the provider on Nov 11, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
3810004159MedicaidWV

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

LicenseStateTypeSpecialty
64165WVMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew 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.

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.

Verify at the official NPI Registry.