Provider Demographics
NPI:1316109630
Name:HENSLEY, AUTUMN LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:LYNN
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5879 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7398
Mailing Address - Country:US
Mailing Address - Phone:580-916-2730
Mailing Address - Fax:
Practice Address - Street 1:1400 BRYAN DR STE 208
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2157
Practice Address - Country:US
Practice Address - Phone:580-920-9063
Practice Address - Fax:833-450-0357
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29039207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program