Provider Demographics
NPI:1982908703
Name:HENSLEY, ALAN
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19801 DOS AMIGO DR
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-6040
Mailing Address - Country:US
Mailing Address - Phone:512-217-6875
Mailing Address - Fax:512-609-8007
Practice Address - Street 1:19801 DOS AMIGO DR
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-6040
Practice Address - Country:US
Practice Address - Phone:512-217-6875
Practice Address - Fax:512-609-8007
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59-3821290251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX593821290OtherTAX ID