Provider Demographics
NPI:1346497435
Name:STANLEY, THOMAS RAY (FNP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RAY
Last Name:STANLEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8696 HERRING CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4347
Mailing Address - Country:US
Mailing Address - Phone:901-759-9143
Mailing Address - Fax:
Practice Address - Street 1:7990 TRINITY RD
Practice Address - Street 2:SUITE 119
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7730
Practice Address - Country:US
Practice Address - Phone:901-753-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily