Basic Information
| Provider Information | |||||||||
| NPI: | 1871849141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENLEY | ||||||||
| FirstName: | RYANN | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BEWLEY | ||||||||
| OtherFirstName: | RYANN | ||||||||
| OtherMiddleName: | ELAINE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | CRNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3115 NORTHINGTON CT STE 138 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356306352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567665762 | ||||||||
| FaxNumber: | 2567408842 | ||||||||
| Practice Location | |||||||||
| Address1: | 541 W COLLEGE ST | ||||||||
| Address2: | SUITE 2600 | ||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356305323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567662600 | ||||||||
| FaxNumber: | 2567662600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2012 | ||||||||
| LastUpdateDate: | 08/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 1-117724 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 511-29678 | 01 | AL | BCBS AL | OTHER | 142282 | 05 | AL | MEDICAID |