Provider Demographics
NPI:1184766024
Name:STANLEY, STEVEN (ARNP)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:STANLEY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 FLEMINGSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1810
Mailing Address - Country:US
Mailing Address - Phone:606-462-8016
Mailing Address - Fax:606-462-8046
Practice Address - Street 1:1350 FLEMINGSBURG RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1810
Practice Address - Country:US
Practice Address - Phone:606-462-8016
Practice Address - Fax:606-462-8046
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005858363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3005858OtherMEDICAL LICENSE
KY7100442290Medicaid