Provider Demographics
NPI:1902403215
Name:HENSON, STACEY FAYE (LPN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:FAYE
Last Name:HENSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 ONION HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-1410
Mailing Address - Country:US
Mailing Address - Phone:931-305-1925
Mailing Address - Fax:
Practice Address - Street 1:1021 SPRING ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3302
Practice Address - Country:US
Practice Address - Phone:931-232-5329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN84371164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse