Provider Demographics
NPI:1164492732
Name:STANLEY, BETTY A (FNP)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:A
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 1:65 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-4380
Mailing Address - Country:US
Mailing Address - Phone:606-376-2224
Mailing Address - Fax:606-376-2205
Practice Address - Street 1:65 CENTER AVE
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-4380
Practice Address - Country:US
Practice Address - Phone:606-376-2224
Practice Address - Fax:606-376-2205
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5568363LF0000X
KY3000474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33479421Medicaid
KY78001302Medicaid
TN33479421Medicare PIN
TNR88252Medicare UPIN
KY78001302Medicaid