Healthcare Provider Details

I. General information

NPI: 1598055287
Provider Name (Legal Business Name): AMY E HENSLEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S NEW BALLAS RD SUITE 2030
SAINT LOUIS MO
63141-8253
US

IV. Provider business mailing address

300 WINDING WOODS DR
O FALLON MO
63366-4771
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-1700
  • Fax: 314-251-5804
Mailing address:
  • Phone: 314-251-1700
  • Fax: 314-251-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011006220
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: