Provider Demographics
NPI:1659027142
Name:STANLY, SARA LANE (FNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LANE
Last Name:STANLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 N GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:FLINTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37335-5404
Mailing Address - Country:US
Mailing Address - Phone:931-993-4247
Mailing Address - Fax:
Practice Address - Street 1:207 ELK AVE S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3051
Practice Address - Country:US
Practice Address - Phone:931-433-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily