Individual
MRS. STACY HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1210 W 18TH ST STE G01, SIOUX FALLS, SD 57104-4651
(605) 328-2663
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
111084
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111804
PA LICENSE
IA
Enumeration date
06/14/2021
Last updated
12/27/2023
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