Provider Demographics
NPI:1356345763
Name:HENSLER, JASON BLAKELY (PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:BLAKELY
Last Name:HENSLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 600
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-0600
Mailing Address - Country:US
Mailing Address - Phone:956-661-8200
Mailing Address - Fax:956-661-8205
Practice Address - Street 1:4865 N. MCCOLL RD.
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-661-8200
Practice Address - Fax:956-661-8205
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03094363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03094OtherLISCENSE NUMBER
TX00772TOtherMEDICARE GRP#
TX8A4709Medicare PIN