1124280953 NPI number — DR. HEATHER HENSLEY D.O.

Table of content: DR. HEATHER HENSLEY D.O. (NPI 1124280953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124280953 NPI number — DR. HEATHER HENSLEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSLEY
Provider First Name:
HEATHER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENSLEY IVY
Provider Other First Name:
HEATHER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124280953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2250 W SOUTHERN AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85202-4736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-830-8333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 E SOUTHERN AVE STE 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-7667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-830-8333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  83764 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 011291 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 011291 . This is a "OSTEOPATHIC PHYSICIAN AND SURGEON" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 83764 . This is a "OSTEOPATHIC PHYSICIAN AND SURGEON" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 6193 . This is a "OSTEOPATHIC PHYSICIAN AND SURGEON" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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