Provider Demographics
NPI:1073820205
Name:HENSLEY, MATTHEW ALLAN (APRN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALLAN
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:2245 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7848
Practice Address - Country:US
Practice Address - Phone:606-408-2600
Practice Address - Fax:606-408-2605
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006582363LF0000X
OH11772-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00962937OtherRR MEDICARE
OHP00901248OtherRR MEDICARE
KY7100144230Medicaid
WV3810019002Medicaid
OH3091032Medicaid
OH3091032Medicaid
OHP00901248OtherRR MEDICARE
WV3810019002Medicaid