Healthcare Provider Details

I. General information

NPI: 1609167527
Provider Name (Legal Business Name): HENSLEY AND JOHNSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W JACKSON ST
COOKEVILLE TN
38501-5940
US

IV. Provider business mailing address

821 W JACKSON ST
COOKEVILLE TN
38501-5940
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-4663
  • Fax:
Mailing address:
  • Phone: 931-528-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN0000119672
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN0000119672
License Number StateTN
# 8
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY MODENA RAY
Title or Position: RN/ADMINISTRATOR
Credential: RN
Phone: 931-224-9039