Provider Demographics
NPI:1861023400
Name:STANLEY, MOLLIE MOORE (NP)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:MOORE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:WOHELING
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5526 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3106
Mailing Address - Country:US
Mailing Address - Phone:512-462-3820
Mailing Address - Fax:
Practice Address - Street 1:5526 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3106
Practice Address - Country:US
Practice Address - Phone:512-462-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily