Healthcare Provider Details

I. General information

NPI: 1417459504
Provider Name (Legal Business Name): JEANINE HENSLEY RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 COLINA TRL
TYLER TX
75707-8003
US

IV. Provider business mailing address

4214 COLINA TRL
TYLER TX
75707-8003
US

V. Phone/Fax

Practice location:
  • Phone: 903-805-6296
  • Fax:
Mailing address:
  • Phone: 903-805-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number250010
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: