Healthcare Provider Details

I. General information

NPI: 1295740009
Provider Name (Legal Business Name): MARLA HENRY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MIDLAND ST
CLARENDON AR
72029-2727
US

IV. Provider business mailing address

401 MIDLAND ST
CLARENDON AR
72029
US

V. Phone/Fax

Practice location:
  • Phone: 870-747-3381
  • Fax:
Mailing address:
  • Phone: 800-244-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01378 APN
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: