Provider Demographics
NPI:1790660785
Name:HENRY, ROBERTA ELAINE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ELAINE
Last Name:HENRY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-4004
Mailing Address - Country:US
Mailing Address - Phone:501-813-0879
Mailing Address - Fax:
Practice Address - Street 1:5505 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6707
Practice Address - Country:US
Practice Address - Phone:501-992-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily