STACEY HENDERSON (NPI# 1649666405) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649666405 |
| Entity Type | Individual |
| Full Name | STACEY HENDERSON |
| Credential | MD |
| Practice Address |
2510 Bert Koun Loop Shreveport LA 71118-3119 |
| Mailing Address |
939 Highway 171 Stonewall LA 71078-9595 |
| Practice Telephone | 3182124000 |
| Mailing Telephone | 3189258825 |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2018-05-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 308050 | LA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1501 Kings Hwy, Em, Shreveport, LA 711034228 | 3186756632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306316294 | Stacey Henderson | Case Manager/Care Coordinator | 1351 Newtown Pike Bldg 1, Lexington, KY 40511-1277 | 2018-12-04 |
| 1013059864 | Stacey Ann Henderson | Physical Therapist | 5105 N Park Dr, Pennsauken, NJ 08109-4630 | 2007-02-12 |
| Street Address |
2510 BERT KOUN LOOP |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71118-3119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992792535 | Giao N Do | Pediatrics | 2510 Bert Koun Loop, Room 4003, Shreveport, LA 71118-3119 | 2005-09-29 |
| 1194059386 | Minh Q Tran | Pediatrics | 2510 Bert Koun Loop, Room 4003, Shreveport, LA 71118-3119 | 2009-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720620784 | Wk Center for Pediatric Gastroenterology | Pediatrics | Wk Center for Pediatric Gastroenterology, 2530 Bert Kouns Industrial Loop, Ste 113, Shreveport, LA 71118 | 2019-10-11 |
| 1306302443 | Diamond Marie Willis | Case Manager/Care Coordinator | 9403 Mansfield Rd., Shreveport, LA 71118 | 2019-02-13 |
| 1194224469 | Latosa Hall | Case Manager/Care Coordinator | 9007 Letha Loop, Shreveport, LA 71118 | 2018-02-01 |
| 1902321623 | Bersheika Lashay Player | Counselor | 9403 Mansfield Road, Shreveport, LA 71118 | 2017-08-03 |
| 1518487149 | Clarke Jackson | Case Manager/Care Coordinator | 9730 Baird Rd Apt 2310, Shreveport, LA 71118 | 2017-06-24 |
| 1770010449 | Darrie'l Smith | Counselor | 2715 Mackey, Shreveport, LA 71118 | 2017-05-12 |
| 1760917041 | Delilah Wells | Case Manager/Care Coordinator | 9005 Walker Rd Apt 722, Shreveport, LA 71118 | 2017-04-25 |
| 1790229664 | We Care Transporttion Services LLC | Secured Medical Transport (VAN) | 2529 Summer Grove Dr, Shreveport, LA 71118 | 2016-12-13 |
| 1063955128 | Commanisha Smith | Social Worker | 2715 Mackey Place, Shreveport, LA 71118 | 2016-11-22 |
| 1023560802 | Yasmin Newman | Counselor | 9812 West Trails End, Shreveport, LA 71118 | 2016-10-27 |
| Find all providers in zip 71118 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982871182 | Edward Locascio | Emergency Medicine | 1512 W Kirby Place, Department of Emergency Medicine, Shreveport, LA 71103-3822 | 2008-05-15 |
| 1780722686 | Joseph Salvador Bianca | Emergency Medicine | 715 Chinquapin Dr, Shreveport, LA 71106-7200 | 2007-02-02 |
| 1902950363 | Richard A Aycock II | Emergency Medicine | 2510 Bert Kouns Indistrial Loop, Shreveport, LA 71118 | 2007-01-23 |
| 1962555342 | Charles Leonard Black | Emergency Medicine | 7600 General Motors Blvd, Medical Department, Shreveport, LA 71129-9426 | 2007-01-19 |
| 1801820121 | Mary Ann Edens | Emergency Medicine | 1501 King's Highway, Shreveport, LA 71103 | 2006-07-10 |
| 1992738629 | Paul Bracey | Emergency Medicine | 6841 Fern Avenue, Suite 100, Shreveport, LA 71105 | 2006-07-08 |
| 1306875570 | Edward Ronald Samper | Emergency Medicine | 1666 E Bert Kouns Industrial Loop, Suite 105, Shreveport, LA 71105-5714 | 2006-07-01 |
| 1366482309 | Kenneth David Miller | Emergency Medicine | 11165 Heritage Oaks, Shreveport, LA 71106-8383 | 2006-06-07 |
| 1225084536 | John Kevin Netterville | Emergency Medicine | One St Mary Place, Shreveport, LA 71101 | 2006-05-26 |
| 1245206077 | Jerel L Raney | Emergency Medicine | 7045 Youree Dr, Shreveport, LA 71105-5108 | 2006-02-23 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71118 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.