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
1	2086S0122X	Plastic and Reconstructive Surgery Physician	312344	LA

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	:	05/23/2022

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