Provider Demographics
NPI:1326223488
Name:HENSLEY, KELLY SUZANNE (BS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUZANNE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:S
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3600
Practice Address - Street 1:607 BAXTER ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4003
Practice Address - Country:US
Practice Address - Phone:423-232-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator