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General NPI Number Information
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NPI Number | 1316109630
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Entity Type | Individual
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Provider Name | AUTUMN LYNN HENSLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 1400 BRYAN DR STE 208
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City | DURANT
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State | OK
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Zip | 74701-2157
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Country | US
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Telephone | 580-920-9063
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Fax | 833-450-0357
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Provider Business Mailing Address
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Address Line | 5879 N WASHINGTON AVE
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City | DURANT
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State | OK
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Zip | 74701-7398
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Country | US
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Telephone | 580-916-2730
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 29039
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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