Provider Demographics
NPI:1598379810
Name:HENSON, ANDREA LEIGH
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:HENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LEIGH
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37050-4371
Mailing Address - Country:US
Mailing Address - Phone:931-237-0716
Mailing Address - Fax:
Practice Address - Street 1:1330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TENNESSEE RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37178-4003
Practice Address - Country:US
Practice Address - Phone:931-721-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant