Provider Demographics
NPI:1417459504
Name:HENSLEY, JEANINE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:JEANINE
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 COLINA TRL
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-8003
Mailing Address - Country:US
Mailing Address - Phone:903-805-6296
Mailing Address - Fax:
Practice Address - Street 1:4214 COLINA TRL
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-8003
Practice Address - Country:US
Practice Address - Phone:903-805-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250010163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health