Healthcare Provider Details

I. General information

NPI: 1932532116
Provider Name (Legal Business Name): ASHLEY HENDRICKS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PERSHING HWY
SMACKOVER AR
71762-2300
US

IV. Provider business mailing address

1400 PERSHING HWY
SMACKOVER AR
71762-2300
US

V. Phone/Fax

Practice location:
  • Phone: 870-725-3471
  • Fax: 870-725-3215
Mailing address:
  • Phone: 870-725-3471
  • Fax: 870-725-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA003938
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: