Provider Demographics
NPI:1841655503
Name:HENSLEY, KELCI MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KELCI
Middle Name:MARIE
Last Name:HENSLEY
Suffix:
Gender:F
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 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:517-265-2422
Mailing Address - Fax:517-264-5926
Practice Address - Street 1:755 HIGH ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1442
Practice Address - Country:US
Practice Address - Phone:517-265-2422
Practice Address - Fax:517-264-5926
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM35150161OtherMEDICARE PIN
MI1841655503Medicaid