Provider Demographics
NPI:1124443957
Name:HENSLEY, CASSIDY (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:CASSIDY
Other - Middle Name:LYNN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7021 W LEE HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:RURAL RETREAT
Mailing Address - State:VA
Mailing Address - Zip Code:24368-2933
Mailing Address - Country:US
Mailing Address - Phone:866-595-3662
Mailing Address - Fax:276-686-6046
Practice Address - Street 1:7021 W LEE HWY
Practice Address - Street 2:SUITE C
Practice Address - City:RURAL RETREAT
Practice Address - State:VA
Practice Address - Zip Code:24368-2933
Practice Address - Country:US
Practice Address - Phone:866-595-3662
Practice Address - Fax:276-686-6046
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVD228B667OtherPTAN
DN2980OtherGROUP PTAN
VA1124443957Medicaid
261083931OtherTAX ID
C10361OtherGROUP ORGANIZATION PTAN
VAVVD228BMedicare PIN
C10361OtherGROUP ORGANIZATION PTAN