Provider Demographics
NPI:1134479272
Name:HENDERSON, JENNIFER A (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3391 N COLLEGE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5461
Mailing Address - Country:US
Mailing Address - Phone:479-439-8120
Mailing Address - Fax:479-439-8304
Practice Address - Street 1:3391 N COLLEGE AVE STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5461
Practice Address - Country:US
Practice Address - Phone:479-439-8120
Practice Address - Fax:479-439-8304
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003771363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily