Provider Demographics
NPI:1003902578
Name:HENSLEY, SALLY RUTH (APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:RUTH
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2726
Mailing Address - Country:US
Mailing Address - Phone:865-617-5081
Mailing Address - Fax:
Practice Address - Street 1:153 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2517
Practice Address - Country:US
Practice Address - Phone:865-471-5110
Practice Address - Fax:865-471-5105
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily