Healthcare Provider Details

I. General information

NPI: 1306559786
Provider Name (Legal Business Name): ROY EUGENE HENRY ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 12/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 11TH ST NW
CEDAR RAPIDS IA
52405-3811
US

IV. Provider business mailing address

1511 14TH AVE SW
CEDAR RAPIDS IA
52404-1729
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-3562
  • Fax:
Mailing address:
  • Phone: 319-540-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG172170
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: