Provider Demographics
NPI:1184028771
Name:MARINA K HENRY APRN PA
Entity Type:Organization
Organization Name:MARINA K HENRY APRN PA
Other - Org Name:ADVANCED PRACTICE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-814-5349
Mailing Address - Street 1:415 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-4615
Mailing Address - Country:US
Mailing Address - Phone:870-836-5013
Mailing Address - Fax:870-836-7961
Practice Address - Street 1:415 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4615
Practice Address - Country:US
Practice Address - Phone:870-836-5013
Practice Address - Fax:870-836-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004148363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty