Provider Demographics
NPI:1467220095
Name:STANLEY, AMANDA (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2883 WADDY RD
Mailing Address - Street 2:
Mailing Address - City:WADDY
Mailing Address - State:KY
Mailing Address - Zip Code:40076-5037
Mailing Address - Country:US
Mailing Address - Phone:502-645-8186
Mailing Address - Fax:
Practice Address - Street 1:2883 WADDY RD
Practice Address - Street 2:
Practice Address - City:WADDY
Practice Address - State:KY
Practice Address - Zip Code:40076-5037
Practice Address - Country:US
Practice Address - Phone:502-645-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4010947367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty