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NPI Code Detail

MEDICARE: DR. STACY HENDERSON M.D.

MEDICARE: DR. STACY HENDERSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0122XPlastic and Reconstructive Surgery Physician312344LA
22086S0122XPlastic and Reconstructive Surgery PhysicianDR.0071172CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457618316
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY HENDERSON M.D.
Provider Business Mailing Address
First Line : 1717 SAINT CHARLES AVE
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70130-5223
Country : US
Telephone Number : 504-899-2800
Fax Number : 504-899-2700
Provider Business Practice Location Address
First Line : 1717 SAINT CHARLES AVE
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70130-5223
Country : US
Telephone Number : 504-899-2800
Fax Number : 504-899-2700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2012
Last Update Date : 06/05/2026

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Directions to “ DR. STACY HENDERSON M.D.” Practice Location

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