Provider Demographics
NPI:1578016523
Name:HENINGTON, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HENINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 E JOE KOELSCH DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74352-2061
Mailing Address - Country:US
Mailing Address - Phone:918-479-5233
Mailing Address - Fax:
Practice Address - Street 1:695 E JOE KOELSCH DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:OK
Practice Address - Zip Code:74352-2061
Practice Address - Country:US
Practice Address - Phone:918-479-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant