Provider Demographics
NPI:1255334280
Name:HENSARLING, JAMES KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNETH
Last Name:HENSARLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4436 MANGUM DR.
Mailing Address - Street 2:STE A
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:601-982-7363
Mailing Address - Fax:601-981-8672
Practice Address - Street 1:4436 MANGUM DR.
Practice Address - Street 2:STE A
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-982-7363
Practice Address - Fax:601-981-8672
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07313207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110048057OtherRAILROAD MEDICARE
MS000010043Medicaid
SC110048057OtherRAILROAD MEDICARE
MSB64951Medicare UPIN