Healthcare Provider Details

I. General information

NPI: 1316089014
Provider Name (Legal Business Name): BRYAN HENLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MEDICAL PARK DR
MARION VA
24354-1100
US

IV. Provider business mailing address

336 S FORK RD
MARION VA
24354-6838
US

V. Phone/Fax

Practice location:
  • Phone: 276-378-1000
  • Fax:
Mailing address:
  • Phone: 276-620-4526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2201
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102202617
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: