Provider Demographics
NPI:1750877353
Name:STANLEY, SAVANNAH (APRN)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:
Other - Last Name:REYNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1018 JESSICA DR
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-7928
Mailing Address - Country:US
Mailing Address - Phone:502-507-9091
Mailing Address - Fax:
Practice Address - Street 1:805 N WHITTINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-7101
Practice Address - Country:US
Practice Address - Phone:440-368-6868
Practice Address - Fax:440-368-6866
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14280852OtherCAQH