Provider Demographics
NPI:1861647489
Name:HENSLEY, ELIZABETH KEELING (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KEELING
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:OATES
Other - Last Name:KEELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 13708
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-3708
Mailing Address - Country:US
Mailing Address - Phone:601-981-0067
Mailing Address - Fax:
Practice Address - Street 1:2046 PETIT BOIS ST S
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-6709
Practice Address - Country:US
Practice Address - Phone:601-981-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10776208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics