Provider Demographics
NPI:1437115805
Name:STANLEY, MARY P (ANP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:STANLEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 JAMES BOWIE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-2335
Mailing Address - Country:US
Mailing Address - Phone:903-614-5950
Mailing Address - Fax:903-614-5955
Practice Address - Street 1:910 JAMES BOWIE DR
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2335
Practice Address - Country:US
Practice Address - Phone:903-614-5950
Practice Address - Fax:903-614-5955
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX520511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA01684OtherLICENSE
AR159612758Medicaid
TX185323601Medicaid
TX8Y0116OtherBLUE CROSS
TX8F0665Medicare ID - Type Unspecified
AR5Y568Medicare ID - Type Unspecified
Q49823Medicare UPIN
TX185323601Medicaid