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General NPI Number Information
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NPI Number | 1316089014
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Entity Type | Individual
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Provider Name | BRYAN HENLEY DO
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 245 MEDICAL PARK DR
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City | MARION
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State | VA
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Zip | 24354-1100
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Country | US
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Telephone | 276-378-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 336 S FORK RD
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City | MARION
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State | VA
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Zip | 24354-6838
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Country | US
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Telephone | 276-620-4526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102202617
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2201
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License Number State | WV
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