Provider Demographics
NPI:1518548528
Name:HENDERSON, KELLY STEVENS (APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:STEVENS
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 ELBERT BURNETT RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-6401
Mailing Address - Country:US
Mailing Address - Phone:828-246-4650
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT DUNSTANS RD STE 100
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2791
Practice Address - Country:US
Practice Address - Phone:828-252-4020
Practice Address - Fax:828-252-4022
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCF03210342363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner