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STACIE HENDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
972 N 600 E, SPANISH FORK, UT 84660-1306
(801) 465-4896
(801) 465-3267
Mailing address
1055 N 500 W, ATTN. CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13182462-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
UT

Other

Enumeration date
05/11/2021
Last updated
03/09/2023
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