Basic Information
| Provider Information | |||||||||
| NPI: | 1538715180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENSON | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 497 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720060497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703472534 | ||||||||
| FaxNumber: | 8332010454 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 MUSEUM RD | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720324785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0193224295 | ||||||||
| FaxNumber: | 5019320020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2019 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | R029803 | AR | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 101YP2500X | P2209019 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.