Basic Information
| Provider Information | |||||||||
| NPI: | 1528535143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENSLEY | ||||||||
| FirstName: | JOHANNA | ||||||||
| MiddleName: | MORGAN | ||||||||
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| Credential: | RN, BSN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 PR 1093 | ||||||||
| Address2: | |||||||||
| City: | FOUKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704605796 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 PINE ST | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755015100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037988000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2018 | ||||||||
| LastUpdateDate: | 01/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R095934 | AR | N | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 367500000X | 124424 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.