Provider Demographics
NPI:1891326765
Name:STANLEY, KELLY JOE (RT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JOE
Last Name:STANLEY
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262449
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-2449
Mailing Address - Country:US
Mailing Address - Phone:214-620-4549
Mailing Address - Fax:
Practice Address - Street 1:6901 AVENUE K
Practice Address - Street 2:109
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074
Practice Address - Country:US
Practice Address - Phone:214-620-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier