Provider Demographics
NPI:1447222344
Name:HENSLEY, TARA (PA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 CENTRAL AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441
Mailing Address - Country:US
Mailing Address - Phone:641-456-5050
Mailing Address - Fax:641-456-5060
Practice Address - Street 1:1720 CENTRAL AVENUE EAST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441
Practice Address - Country:US
Practice Address - Phone:641-456-5050
Practice Address - Fax:641-456-5060
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0355010044Medicare NSC
IAP26908Medicare UPIN
IAI1469Medicare ID - Type Unspecified