Doctor Name: | JESSICA STANLEY |
NPI Number: | 1073837258 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 14868 |
Business Practice Address: | 1017 Executive Dr Suite 101 Hixson, TN - 373437910 |
Business Phone Number: | 4238701999 |
Business Fax Number: | |
Mailing Address: | 1017 Executive Dr, Suite 101 HIXSON |
State: | TN |
Postal Code: | 373437910 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/17/2010 |
NPI Last Update Date: | 07/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 14868 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |