MR. KELLY HENRY (NPI# 1245724723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245724723 |
| Entity Type | Individual |
| Full Name | MR. KELLY HENRY |
| Credential | NNP |
| Practice Address |
11 Upper Riverdale Rd Sw Riverdale GA 30274 |
| Mailing Address |
272 W Mcintosh Rd Brooks GA 30205-2113 |
| Practice Telephone | 7709918000 |
| Mailing Telephone | 4046046279 |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2018-11-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WN0002X |
Registered Nurse Specialization: Neonatal Intensive Care |
RN235639 | GA | Nursing Service Providers |
| Y | 363LN0000X |
Nurse Practitioner Specialization: Neonatal |
RN235639 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LN0005X |
Nurse Practitioner Specialization: Neonatal, Critical Care |
RN235639 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699835983 | Kelly Paul Henry | Chiropractor | 1234 W Pierce St, Carlsbad, NM 88220-4017 | 2006-12-09 |
| 1760936165 | Kelly Henry | Social Worker | 716 Adair Ave, Zanesville, OH 43701-2836 | 2016-08-15 |
| 1568863355 | Kelly Henry | Physician Assistant | 1215 E Michigan Ave, Lansing, MI 48912-1811 | 2014-09-11 |
| 1447651203 | Kelly Jean Henry | Counselor | 1320 Mendota St Ste 120, Madison, WI 53714-1060 | 2014-09-11 |
| 1457657793 | Kelly Diane Henry | Registered Nurse | 450 Country Club Rd, Suite 340, Eugene, OR 97401-6077 | 2011-02-03 |
| 1194958355 | Kelly Lee Henry | Registered Nurse | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2009-09-03 |
| 1245460641 | Kelly Michelle Henry | Internal Medicine | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2009-07-20 |
| 1023041639 | Kelly M Henry | Registered Nurse | 264 Elm St, Jeffrey Korff Md, Northampton, MA 01060 | 2006-07-08 |
| Street Address |
11 UPPER RIVERDALE RD SW |
| City | RIVERDALE |
| State | GA |
| Zip Code | 30274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831190958 | Southern Regional Health System, Inc | General Acute Care Hospital | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2005-08-10 |
| 1639796212 | Georgia Em-i Medical Service PC | Physician Assistant | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2020-06-30 |
| 1093331308 | Harmony Grove Emergency Physicians LLC | Emergency Medicine | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2020-06-23 |
| 1366092827 | Evan Chandler Burrowes | Dietitian, Registered | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2019-09-17 |
| 1932676681 | Ashley Lauren King | Physician Assistant | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2018-10-31 |
| 1518440254 | Prime Healthcare Foundation - Southern Regional, LLC | Psychiatric Unit | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2018-09-10 |
| 1730660093 | Virginia Tittle Kee | Nurse Practitioner | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2018-08-24 |
| 1053821777 | Angelyn Levell-smith | Nurse Practitioner | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2017-10-08 |
| 1932625548 | Lpp of Georgia LLC | Emergency Medicine | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2017-08-15 |
| 1356898506 | Pathologists At Riverdale | Pathology | 11 Upper Riverdale Rd Sw, Riverdale, GA 30274-2615 | 2016-09-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245862507 | Todd L. Reed | Chiropractor | 83 Upper Riverdale Rd, Riverdale, GA 30274 | 2020-02-05 |
| 1487135992 | Freddie L Sallette IIi | Technician, Pathology | 385 Brookview Dr, Riverdale, GA 30274 | 2018-08-22 |
| 1366933210 | Dawn A. Paul | Nurse Practitioner | 238 Professional Ct Ste A, Riverdale, GA 30274 | 2018-05-27 |
| 1851894588 | Absolute Health Family & Urgent Care Clinic | Clinic/Center | 7574 Ga 85, Riverdale, GA 30274 | 2018-03-08 |
| 1366972127 | Jamillah Ingram | Physical Therapy Assistant | 315 Upper Riverdale Rd., Riverdale, GA 30274 | 2017-06-14 |
| 1114456514 | Grace L Kelson | Licensed Practical Nurse | 9142 Clubhouse Dr, Riverdale, GA 30274 | 2017-06-08 |
| 1790167799 | Cristian Carbuccia | Internal Medicine | 33 Upper Riverdale Rd Sw Ste 10, Riverdale, GA 30274 | 2015-06-25 |
| 1265857692 | Right Choice Enterprises LLC | Technician | 638 Sterling Ct, Riverdale, GA 30274 | 2014-02-21 |
| 1942571625 | Lowes Guardian Angel LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7056 Eunice Dr., Riverdale, GA 30274 | 2012-01-26 |
| 1508134156 | Education System Management, Inc | Social Worker | 125 Highway 138, Riverdale, GA 30274 | 2011-12-12 |
| Find all providers in zip 30274 | ||||
| Taxonomy Code | 363LN0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Neonatal |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265944896 | Jennifer Michelle Kerhin | Nurse Practitioner | 777 Hemlock St Fl 3, Macon, GA 31201-2102 | 2017-11-05 |
| 1871034587 | Stephanie Joseph | Nurse Practitioner | 4316 Sublime Trl, Atlanta, GA 30349-8882 | 2017-03-14 |
| 1659810935 | Stephanie Gale Devers | Nurse Practitioner | 52 Johnny Wortham Rd, Newnan, GA 30263-4823 | 2017-02-19 |
| 1851757520 | Dawn Michelle Tripp | Nurse Practitioner | 10141 Flat Shoals Rd Sw, Covington, GA 30014-3707 | 2016-01-11 |
| 1295080414 | Christa Noel Brown | Nurse Practitioner | 142 Bryce Ryan Cir, Kingsland, GA 31548-7812 | 2012-07-14 |
| 1336398726 | Robin Domm Burch | Nurse Practitioner | 1790 Mulkey Rd Ste 10, Newborn Clinics of America LLC At Wellstar Cobb Clinic, Austell, GA 30106-1122 | 2008-09-10 |
| 1073730032 | Diane Arlene Doherty-chandler | Nurse Practitioner | 1191 Arbor Ln, Madison, GA 30650-3791 | 2007-04-19 |
| 1396886370 | Barbara Elaine Smith | Nurse Practitioner | 5335 Spot Creek Dr, Cumming, GA 30040-9554 | 2007-02-10 |
| 1245315118 | Sara Gelson Martin | Nurse Practitioner | 1762 Clifton Rd Ne Ste 103, Emory University, Atlanta, GA 30322-4001 | 2006-10-26 |
| 1861450058 | Paula Lynn Young | Nurse Practitioner | 2701 North Decatur Rd, Dekalb Medical Center, Decatur, GA 30033 | 2006-05-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.