Healthcare Provider Details

I. General information

NPI: 1750917365
Provider Name (Legal Business Name): REGINA YVONNE HENSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 GARDINER LN APT 217
LOUISVILLE KY
40205-2715
US

IV. Provider business mailing address

1600 GARDINER LN APT 217
LOUISVILLE KY
40205-2715
US

V. Phone/Fax

Practice location:
  • Phone: 812-572-1090
  • Fax:
Mailing address:
  • Phone: 812-572-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: