Kadeidra Simone Henry | Amityville, NY • PECOS Search

Kadeidra Simone Henry

Licensed Practical Nurse

Nursing Service Providers

67 Benburb St, Amityville, NY 11701-1403

PECOS Enrollment

Based on the most recent information from CMS, provider Kadeidra Simone Henry does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1528797982
Provider Type
Individual
Full Name
Henry, Kadeidra Simone
Credential
LPN

Gender
Female
Sole Proprietor
Yes
Enumeration Date
6/9/2022
Last Updated
6/9/2022

Contact Information

Practice Location

67 Benburb St, Amityville, NY 11701-1403

Unlisted Fax

Mailing Location

67 Benburb St, Amityville, NY 11701-1403

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 164W00000X Primary	Description Licensed Practical Nurse Nursing Service Providers	License 331373 New York