Provider Demographics
NPI:1083025118
Name:HENSLEY, CHASITY C
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:C
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WILTON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-6405
Mailing Address - Country:US
Mailing Address - Phone:423-487-2222
Mailing Address - Fax:423-623-7787
Practice Address - Street 1:103 WILTON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-6405
Practice Address - Country:US
Practice Address - Phone:423-487-2222
Practice Address - Fax:423-623-7787
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006709Medicaid