Provider Demographics
NPI:1730853649
Name:STANLEY, AMANDA R (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:STANLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9807 FARM ROAD 114
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75426-7416
Mailing Address - Country:US
Mailing Address - Phone:903-495-3898
Mailing Address - Fax:
Practice Address - Street 1:9807 FARM ROAD 114
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75426-7416
Practice Address - Country:US
Practice Address - Phone:903-495-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX756988163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics