Healthcare Provider Details

I. General information

NPI: 1952210015
Provider Name (Legal Business Name): STACY HENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 RILEY CIR
ALMA AR
72921-4055
US

IV. Provider business mailing address

1302 RILEY CIR
ALMA AR
72921-4055
US

V. Phone/Fax

Practice location:
  • Phone: 479-236-4769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberR064437
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: