Healthcare Provider Details

I. General information

NPI: 1679539928
Provider Name (Legal Business Name): MICHAEL CONLEY HENDREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N EL PASO AVE
RUSSELLVILLE AR
72801-3737
US

IV. Provider business mailing address

30 BURTON HILLS BLVD STE 175
NASHVILLE TN
37215-6403
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-4177
  • Fax:
Mailing address:
  • Phone: 615-988-2014
  • Fax: 615-523-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-5062
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: