Provider Demographics
NPI:1770571879
Name:HENSLEY, JENNIFER (CNM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7718 WOOD HOLLOW DR STE 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1601
Mailing Address - Country:US
Mailing Address - Phone:512-279-6701
Mailing Address - Fax:512-279-6750
Practice Address - Street 1:12201 RENFERT WAY STE 225
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5369
Practice Address - Country:US
Practice Address - Phone:303-873-5245
Practice Address - Fax:303-873-5240
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134014367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03676889Medicaid
COCF72628Medicare PIN
COC810259Medicare PIN