Provider Demographics
NPI:1659038339
Name:HENSLEY, PATRICIA D
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
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 1:312 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3206
Mailing Address - Country:US
Mailing Address - Phone:304-784-1512
Mailing Address - Fax:
Practice Address - Street 1:312 1ST AVE
Practice Address - Street 2:
Practice Address - City:WEST LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3206
Practice Address - Country:US
Practice Address - Phone:304-784-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator