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General NPI Number Information
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NPI Number | 1134690944
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Entity Type | Individual
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Provider Name | CRYSTAL D HENSLEY RN, CDE
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 109 KERR AVE
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City | POTEAU
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State | OK
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Zip | 74953-5270
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Country | US
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Telephone | 918-649-1100
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Fax | 918-649-1103
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Provider Business Mailing Address
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Address Line | PO BOX 1577
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City | DURANT
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State | OK
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Zip | 74702-1577
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Country | US
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Telephone | 580-916-9140
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Fax | 580-916-9142
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 83974
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License Number State | OK
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