Healthcare Provider Details

I. General information

NPI: 1518011493
Provider Name (Legal Business Name): DAWN J HENSLEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E 19TH ST STE 302
TULSA OK
74104-5405
US

IV. Provider business mailing address

1705 E 19TH ST STE 302
TULSA OK
74104-5410
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7585
  • Fax: 918-748-7539
Mailing address:
  • Phone: 918-832-6049
  • Fax: 918-832-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4522
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4522
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: