Individual
MRS. CASSIDY HENSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
7021 W LEE HWY, SUITE C, RURAL RETREAT, VA 24368-2933
(866) 595-3662
(276) 686-6046
Mailing address
7021 W LEE HWY, SUITE C, RURAL RETREAT, VA 24368-2933
(866) 595-3662
(276) 686-6046
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024171512
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124443957
—
VA
01
—
261083931
TAX ID
—
01
—
C10361
GROUP ORGANIZATION PTAN
—
01
—
DN2980
GROUP PTAN
—
01
—
VVD228B667
PTAN
VA
Enumeration date
03/04/2014
Last updated
12/18/2018
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