Provider Demographics
NPI:1164103792
Name:HENSLEY, KRISTY ELISE FOX
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:ELISE FOX
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 1:239 SYCAMORE DR APT SUITE
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5813
Mailing Address - Country:US
Mailing Address - Phone:407-595-5140
Mailing Address - Fax:
Practice Address - Street 1:108 E MAIN ST STE 210B
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4257
Practice Address - Country:US
Practice Address - Phone:423-530-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional