Provider Demographics
NPI:1619236379
Name:STANLEY, KYLEE VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLEE
Middle Name:VICTORIA
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:680 E FREMONT MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2309
Mailing Address - Country:US
Mailing Address - Phone:402-727-5200
Mailing Address - Fax:402-721-5230
Practice Address - Street 1:680 E FREMONT MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2309
Practice Address - Country:US
Practice Address - Phone:402-727-5200
Practice Address - Fax:402-721-5230
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2018-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE6675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6675OtherTEP NUMBER