Provider Demographics
NPI:1174610562
Name:HENSLEY, KERRY LEE (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:LEE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:LEE
Other - Last Name:ROHRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7376 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8662
Mailing Address - Country:US
Mailing Address - Phone:317-272-7887
Mailing Address - Fax:317-272-7888
Practice Address - Street 1:7376 BUSINESS CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8662
Practice Address - Country:US
Practice Address - Phone:317-272-7887
Practice Address - Fax:317-272-7888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200140570CMedicaid
IN200140570BMedicaid
IN200140570CMedicaid