Healthcare Provider Details

I. General information

NPI: 1134577208
Provider Name (Legal Business Name): MARY H HOLSCLAW DNP, APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY F HENRY DNP APRN, NNP-BC

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY SLOT 211
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

1 CHILDRENS WAY # 653
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-7087
  • Fax:
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-364-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberA004738
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: