Provider Demographics
NPI:1689669566
Name:STANLEY, JESSICA R (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:STANLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4000
Mailing Address - Street 2:BUILDING 8 DOGWOOD AVENUE
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-4000
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3554
Practice Address - Street 1:CORNER OF LAMONT AND VETERANS WAY
Practice Address - Street 2:BUILDING 200
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684-4000
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3554
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3095873Medicaid
TNP11484Medicare UPIN
TN3095873Medicaid