Individual
KELLY HENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1010 MEDICAL CENTER DR, POWDERLY, KY 42367-5463
(270) 377-1600
(270) 338-0229
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 243-4900
(502) 489-5750
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1023
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100022430
—
KY
01
—
PA1023
PHYSICIAN ASSISTANCE LICENSE
KY
Enumeration date
03/06/2007
Last updated
12/16/2020
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