Provider Demographics
NPI:1235801960
Name:HENRY, JOYCE BEA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:BEA
Last Name:HENRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 EAST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0801
Mailing Address - Country:US
Mailing Address - Phone:530-515-2858
Mailing Address - Fax:
Practice Address - Street 1:1355 EAST ST STE 200
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0801
Practice Address - Country:US
Practice Address - Phone:530-515-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95018504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF95018504OtherBOARD OF REGISTERED NURSING CERTIFICATE NUMBER