Healthcare Provider Details

I. General information

NPI: 1316026834
Provider Name (Legal Business Name): SANDRA KAY HENSLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 WILLIAMSBURG DR STE 3
JEFFERSONVILLE IN
47130-8065
US

IV. Provider business mailing address

1730 WILLIAMSBURG DR STE 3
JEFFERSONVILLE IN
47130-8065
US

V. Phone/Fax

Practice location:
  • Phone: 812-246-0705
  • Fax: 812-246-0710
Mailing address:
  • Phone: 122-460-7058
  • Fax: 812-246-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29708
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01043740
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: