Provider Demographics
NPI:1932532116
Name:HENDRICKS, ASHLEY (CPNP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PERSHING HWY
Mailing Address - Street 2:
Mailing Address - City:SMACKOVER
Mailing Address - State:AR
Mailing Address - Zip Code:71762-2300
Mailing Address - Country:US
Mailing Address - Phone:870-725-3471
Mailing Address - Fax:870-725-3215
Practice Address - Street 1:1400 PERSHING HWY
Practice Address - Street 2:
Practice Address - City:SMACKOVER
Practice Address - State:AR
Practice Address - Zip Code:71762-2300
Practice Address - Country:US
Practice Address - Phone:870-725-3471
Practice Address - Fax:870-725-3215
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003938363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics