Provider Demographics
NPI:1952497547
Name:HENLEY, JOHN BURTON II (MS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BURTON
Last Name:HENLEY
Suffix:II
Gender:M
Credentials:MS, PA-C
Other - Prefix:
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Mailing Address - Street 1:300 JEROME DRIVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-376-6493
Mailing Address - Fax:
Practice Address - Street 1:1500 DEBARR RD
Practice Address - Street 2:VAMROC OUTPATIENT CLINIC
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99514-3707
Practice Address - Country:US
Practice Address - Phone:907-257-4950
Practice Address - Fax:907-257-6784
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK44363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical