Provider Demographics
NPI:1487194791
Name:HENNIGAR, STACY N (NP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:N
Last Name:HENNIGAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-1978
Mailing Address - Country:US
Mailing Address - Phone:515-205-5871
Mailing Address - Fax:
Practice Address - Street 1:7300 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2527
Practice Address - Country:US
Practice Address - Phone:515-650-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA105594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1487194791OtherNPI NUMBER
IAA105594OtherIOWA LICENSE
IA560910074Medicare PIN