Individual
STACY HENRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1090 NE GATEWAY CT NE, STE 204, CONCORD, NC 28025-2414
(704) 403-7020
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5003123
NC
Other
Enumeration date
07/25/2007
Last updated
01/20/2021
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