Provider Demographics
NPI:1831136407
Name:HENSLEY, ROBERT V (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:V
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 MAHANEY AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5794
Mailing Address - Country:US
Mailing Address - Phone:918-207-1900
Mailing Address - Fax:918-207-0711
Practice Address - Street 1:2021 MAHANEY AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5794
Practice Address - Country:US
Practice Address - Phone:918-207-1900
Practice Address - Fax:918-207-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100254920AMedicaid
OK100254920AMedicaid