Provider Demographics
NPI:1710661772
Name:HENSLEY, KARLYE
Entity type:Individual
Prefix:
First Name:KARLYE
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21516 BRIDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:QUAKER CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43773-9719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3194 CORE RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1556
Practice Address - Country:US
Practice Address - Phone:304-485-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008723RX363A00000X
WV2774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant