Provider Demographics
NPI:1942321260
Name:STANSBURY, PATRICK ALAN (PHYSICIAN ASST-CERT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ALAN
Last Name:STANSBURY
Suffix:
Gender:M
Credentials:PHYSICIAN ASST-CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WHITE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1411
Mailing Address - Country:US
Mailing Address - Phone:615-352-0011
Mailing Address - Fax:615-352-1752
Practice Address - Street 1:24 WHITE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1411
Practice Address - Country:US
Practice Address - Phone:615-352-0011
Practice Address - Fax:615-352-1752
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN521363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN#521OtherMEDICAL LISCENSE- PA-C