Provider Demographics
NPI:1073567046
Name:HENSLEY FAMILY CARE CLINIC PC
Entity Type:Organization
Organization Name:HENSLEY FAMILY CARE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-735-1650
Mailing Address - Street 1:SUITE 700
Mailing Address - Street 2:133 HOSPITAL DRIVE
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-4010
Mailing Address - Country:US
Mailing Address - Phone:615-735-1650
Mailing Address - Fax:615-735-1658
Practice Address - Street 1:STE700
Practice Address - Street 2:133 HOSPITAL DRIVE
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-4010
Practice Address - Country:US
Practice Address - Phone:615-735-1650
Practice Address - Fax:615-735-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3903357Medicaid
TNS81023Medicare UPIN
TN3903357Medicaid