Provider Demographics
NPI:1093791550
Name:STANLEY, KATHERINE K (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:K
Last Name:STANLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10209
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-0209
Mailing Address - Country:US
Mailing Address - Phone:850-476-4200
Mailing Address - Fax:866-684-0566
Practice Address - Street 1:1900 SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-3359
Practice Address - Country:US
Practice Address - Phone:850-436-5900
Practice Address - Fax:850-436-5959
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1269722363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302160200Medicaid
FLY6580OtherBSFL
FLY6580OtherBSFL