Provider Demographics
NPI:1154302958
Name:HENSON, OLA MERLE (CFNP)
Entity Type:Individual
Prefix:
First Name:OLA
Middle Name:MERLE
Last Name:HENSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3265
Mailing Address - Country:US
Mailing Address - Phone:931-393-2362
Mailing Address - Fax:931-393-3212
Practice Address - Street 1:622 WILSON AVE
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3265
Practice Address - Country:US
Practice Address - Phone:931-393-2362
Practice Address - Fax:931-393-3212
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN06613363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3909621Medicaid
TN3909621Medicare ID - Type Unspecified
TN3909621Medicaid