Individual
CARLEY HENNESSY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 11TH ST W, WILLISTON, ND 58801-4500
(701) 774-7687
Mailing address
1700 11TH ST W, WILLISTON, ND 58801-4500
(701) 774-7687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PAC0617
ND
363AS0400X
Surgical Physician Assistant
Primary
MED-PAC-LIC-76234
MT
Other
Enumeration date
10/07/2015
Last updated
12/14/2021
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