Provider Demographics
NPI:1497999155
Name:STANLEY, SUZETTE CARROLL (RN APN FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:CARROLL
Last Name:STANLEY
Suffix:
Gender:F
Credentials:RN APN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 YORK COMMONS
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-6088
Mailing Address - Country:US
Mailing Address - Phone:731-635-1327
Mailing Address - Fax:
Practice Address - Street 1:317 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-1205
Practice Address - Country:US
Practice Address - Phone:731-221-1804
Practice Address - Fax:731-221-1880
Is Sole Proprietor?:No
Enumeration Date:2009-04-26
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I501930OtherMEDICARE PTAN
TN4319063OtherBLUE CROSS BLUE SHIELD
TN1526784Medicaid