Provider Demographics
NPI:1073285482
Name:STANLEY, JACKLYN KAY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:KAY
Last Name:STANLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:939 SUNSET RD SW
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62824-1113
Mailing Address - Country:US
Mailing Address - Phone:618-844-3224
Mailing Address - Fax:
Practice Address - Street 1:939 SUNSET RD SW
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:IL
Practice Address - Zip Code:62824-1113
Practice Address - Country:US
Practice Address - Phone:686-662-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024537363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health