NPIMap

Organization Active NPI

Henderson State University

  • Family Medicine Physician
  • Arkadelphia, AR
National Provider Identifier
1043968894
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HENDERSON STATE UNIVERSITY
Practice address
1100 Henderson St
Arkadelphia, AR 71999-0001
Phone
(870) 230-5102
NPI assigned
Mar 11, 2022
Organization subpart
Yes
Parent organization
HENDERSON STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Renee Walls, APRNNPI 1790876753
Title
Interim Director
Phone
(870) 230-5102

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1100 Henderson St
Arkadelphia, AR 71999-0001

Mailing address

1100 Henderson St
Arkadelphia, AR 71999-0001
Phone (870) 230-5102

Other names 1

  • Student Health and Wellness Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Henderson State University2 organizations share this tax ID, including this one
Part of
Henderson State University

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1043968894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 HENDERSON ST",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719990001",
            "telephone_number": "870-230-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 HENDERSON ST",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719990001",
            "telephone_number": "870-230-5102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HENDERSON STATE UNIVERSITY",
        "enumeration_date": "2022-03-11",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "WALLS",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "INTERIM DIRECTOR",
        "authorized_official_telephone_number": "870-230-5102",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Student Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Student Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arkadelphia, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.