Healthcare Provider Details

I. General information

NPI: 1104213289
Provider Name (Legal Business Name): AMY LEIGH HENSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LEIGH MILLER

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ADCOCK RD STE D
HOT SPRINGS AR
71913-7958
US

IV. Provider business mailing address

1661 AIRPORT RD STE D
HOT SPRINGS AR
71913-8184
US

V. Phone/Fax

Practice location:
  • Phone: 501-547-5961
  • Fax: 501-651-4296
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004345
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: