Provider Demographics
NPI:1982008298
Name:HENSLEY, KALEB D
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:D
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 66 BOX 60
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74760-9410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 66 BOX 60
Practice Address - Street 2:
Practice Address - City:SPENCERVILLE
Practice Address - State:OK
Practice Address - Zip Code:74760-9410
Practice Address - Country:US
Practice Address - Phone:580-212-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator