Provider Demographics
NPI:1124280953
Name:HENSLEY, HEATHER (DO)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:HENSLEY IVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2250 W SOUTHERN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4736
Mailing Address - Country:US
Mailing Address - Phone:480-830-8333
Mailing Address - Fax:
Practice Address - Street 1:2501 E SOUTHERN AVE STE 18
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7667
Practice Address - Country:US
Practice Address - Phone:480-830-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83764207N00000X
AZ011291207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ011291OtherOSTEOPATHIC PHYSICIAN AND SURGEON
GA83764OtherOSTEOPATHIC PHYSICIAN AND SURGEON
OK6193OtherOSTEOPATHIC PHYSICIAN AND SURGEON