Individual provider Active NPI

Laura Copeland Henley, RDMS

  • Sonography Radiologic Technologist
  • Fenton, MO
National Provider Identifier
1104569870
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sonography Radiologic TechnologistTaxonomy code 2471S1302X
License
116610 Issued in MO
Practice address
794 Gravois Bluffs Blvd Ste C
Fenton, MO 63026-7721
Phone
(314) 835-7935
NPI assigned
Apr 19, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sonography Radiologic TechnologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2471S1302X 116610 MO Primary

Addresses

Primary practice location

794 Gravois Bluffs Blvd Ste C
Fenton, MO 63026-7721

Mailing address

794 Gravois Bluffs Blvd Ste C
Fenton, MO 63026-7721
Phone (314) 479-1504

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
116610MOMDSonography Radiologic Technologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1104569870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 GRAVOIS BLUFFS BLVD STE C",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267721",
            "telephone_number": "314-479-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "794 GRAVOIS BLUFFS BLVD STE C",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267721",
            "telephone_number": "314-835-7935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENLEY",
        "first_name": "LAURA",
        "middle_name": "COPELAND",
        "name_prefix": "Mrs.",
        "credential": "RDMS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471S1302X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Sonography",
            "state": "MO",
            "license": "116610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.