Individual
DR. KIMBERLY HENLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2115
(417) 820-5344
Mailing address
PO BOX 504274, SAINT LOUIS, MO 63150-4274
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2008032273
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083884043
—
MO
05
—
206334001
—
AR
01
—
440552485
TRICARE
MO
Enumeration date
03/06/2008
Last updated
04/08/2015
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