Provider Demographics
NPI:1902495252
Name:STANLEY, NATASHA (FNP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-0930
Mailing Address - Country:US
Mailing Address - Phone:276-393-3110
Mailing Address - Fax:
Practice Address - Street 1:205 E 19TH ST N
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3468
Practice Address - Country:US
Practice Address - Phone:276-524-4920
Practice Address - Fax:276-524-4921
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner