Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Stacie Henderson, PA

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1982288486

Stacie Henderson, PA is a Physician Assistant in Spanish Fork, Utah. Graduated from University of Utah School of Medicine in 2022, 4 years ago. Practices with Revere Health PC, a 410-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
4
Trained at
University of Utah School of Medicine
Licensed in
UT
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

972 N 600 E
Spanish Fork, UT 84660-1306
Phone: (801) 465-4896
Fax: (801) 465-3267
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 13182462-1206 (UT)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (UT)

Record details

NPI number1982288486
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 11, 2021
Last updated in NPPESMarch 9, 2023
Certification dateMarch 9, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolUNIVERSITY OF UTAH SCHOOL OF MEDICINE
Graduated 2022 (4 years in practice)
Group practice Revere Health Pc — 410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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