1861966525 NPI number — MRS. CATHERINE ANN HENSLEY FNP-C

Table of content: MRS. CATHERINE ANN HENSLEY FNP-C (NPI 1861966525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861966525 NPI number — MRS. CATHERINE ANN HENSLEY FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSLEY
Provider First Name:
CATHERINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861966525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#8 SHERIDAN SQUARE
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-246-6445
Provider Business Mailing Address Fax Number:
423-246-8240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#8 SHERIDAN SQUARE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-246-6445
Provider Business Practice Location Address Fax Number:
423-246-8240
Provider Enumeration Date:
01/16/2019

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: 363LP2300X , with the licence number:  25300 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25300 . This is a "TN LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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