MEDICARE: DR. HEATHER HENSLEY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	83764	GA
2	207N00000X	Dermatology Physician	011291	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011291	OTHER	AZ	OSTEOPATHIC PHYSICIAN AND SURGEON
2	83764	OTHER	GA	OSTEOPATHIC PHYSICIAN AND SURGEON
3	6193	OTHER	OK	OSTEOPATHIC PHYSICIAN AND SURGEON

General Provider Information

NPI Number	:	1124280953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER HENSLEY D.O.

Provider Business Mailing Address
First Line	:	2250 W SOUTHERN AVE STE 102
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-4736
Country	:	US
Telephone Number	:	480-830-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 E SOUTHERN AVE STE 18
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7667
Country	:	US
Telephone Number	:	480-830-8333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	12/27/2024

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Directions to “ DR. HEATHER HENSLEY D.O.” Practice Location

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