Provider Demographics
NPI:1427086503
Name:HENSLEY, NANCY LUCILLE (PA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LUCILLE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MIDDLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5016
Mailing Address - Country:US
Mailing Address - Phone:865-908-9888
Mailing Address - Fax:865-908-8756
Practice Address - Street 1:715 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5016
Practice Address - Country:US
Practice Address - Phone:865-908-9888
Practice Address - Fax:865-908-8756
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA623363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4115987OtherBCBST
TN4115987OtherBCBST
TN3667605Medicare ID - Type Unspecified