Healthcare Provider Details

I. General information

NPI: 1396689790
Provider Name (Legal Business Name): KENEDIE HENLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 S MAIN ST
STUTTGART AR
72160-7008
US

IV. Provider business mailing address

2501 S MAIN ST
STUTTGART AR
72160-7008
US

V. Phone/Fax

Practice location:
  • Phone: 870-673-8701
  • Fax: 870-673-7337
Mailing address:
  • Phone: 870-673-8701
  • Fax: 870-673-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A2209
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: