Provider Demographics
NPI:1447222344
Name:HENSLEY, TARA (PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 AMHERST BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:IA
Mailing Address - Zip Code:50658-9712
Mailing Address - Country:US
Mailing Address - Phone:641-435-4133
Mailing Address - Fax:888-927-0628
Practice Address - Street 1:80 AMHERST BLVD STE 400
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:IA
Practice Address - Zip Code:50658-9712
Practice Address - Country:US
Practice Address - Phone:641-435-4133
Practice Address - Fax:888-927-0628
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0355010044Medicare NSC
IAP26908Medicare UPIN
IAI1469Medicare ID - Type Unspecified