Basic Information
| Provider Information | |||||||||
| NPI: | 1790146694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENLEY | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | LEGLER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3632 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826043164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072346765 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3632 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826043164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072346765 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2016 | ||||||||
| LastUpdateDate: | 03/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 27697.1500 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.