Provider Demographics
NPI:1043455561
Name:HENRY, ARTANGELA DEMETRIA (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:ARTANGELA
Middle Name:DEMETRIA
Last Name:HENRY
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 75947
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275
Mailing Address - Country:US
Mailing Address - Phone:901-516-8785
Mailing Address - Fax:901-516-8358
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-516-8785
Practice Address - Fax:901-516-8358
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14169363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3707256Medicare Oscar/Certification