Individual
MRS. STEPHANIE KAY HENDRICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6520 N HWY 23, NEWTON, UT 84327
(435) 890-0369
Mailing address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
(208) 542-9114
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11899073-1206
UT
363A00000X
Physician Assistant
PA-1976
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11899073-1206
STATE LICENSE
UT
Enumeration date
05/11/2020
Last updated
12/22/2020
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