MEDICARE: MIKALA HENSLEY FNP-C

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	363LF0000X	Family Nurse Practitioner	221802	OK

General Provider Information

NPI Number	:	1477367357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKALA HENSLEY FNP-C

Provider Business Mailing Address
First Line	:	581 SE 3RD ST
Second Line	:
City	:	ADAIR
State	:	OK
Zip	:	74330-2258
Country	:	US
Telephone Number	:	918-530-1878
Fax Number	:

Provider Business Practice Location Address
First Line	:	2518 N MAIN ST
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354-1602
Country	:	US
Telephone Number	:	918-540-9077
Fax Number	:

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

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	02/03/2025

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