Provider Demographics
NPI:1669519393
Name:HENSLEY, KELLI (ARNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-2312
Mailing Address - Country:US
Mailing Address - Phone:606-573-3700
Mailing Address - Fax:606-573-6128
Practice Address - Street 1:402 E CLOVER ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2312
Practice Address - Country:US
Practice Address - Phone:606-573-3700
Practice Address - Fax:606-573-6128
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4105P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0275313Medicare ID - Type Unspecified