Provider Demographics
NPI:1033134408
Name:STANLY REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:STANLY REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/CWOCN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CS-FNP, CWOCN
Authorized Official - Phone:704-984-4595
Mailing Address - Street 1:301 YADKIN ST
Mailing Address - Street 2:P.O. BOX 1489
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3441
Mailing Address - Country:US
Mailing Address - Phone:704-984-4595
Mailing Address - Fax:704-984-4132
Practice Address - Street 1:313 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-984-4595
Practice Address - Fax:704-984-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201510363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000232Medicaid
NCP47366Medicare UPIN
NC2802507Medicare ID - Type Unspecified