Provider Demographics
NPI:1043654452
Name:GENTRY, CAROLYN S (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:GENTRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLIDAY ISLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72631-9216
Mailing Address - Country:US
Mailing Address - Phone:479-253-6844
Mailing Address - Fax:479-253-6844
Practice Address - Street 1:1 PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:HOLIDAY ISLAND
Practice Address - State:AR
Practice Address - Zip Code:72631-9216
Practice Address - Country:US
Practice Address - Phone:479-253-6844
Practice Address - Fax:479-253-6844
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR35851163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse