Individual
KELLEY O HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
110 MORDINGTON AVENUE, JEFFERSON COUNTY BOARD OF EDUCATION, CHARLES TOWN, WV 25414
(304) 267-3595
Mailing address
110 MORDINGTON AVENUE, JEFFERSON COUNTY BOARD OF EDUCATION, CHARLES TOWN, WV 25414
(304) 267-3595
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
64165
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810004159
—
WV
Enumeration date
11/11/2009
Last updated
11/11/2009
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