Provider Demographics
NPI:1932162526
Name:STANLEY, KANDY SUE
Entity Type:Individual
Prefix:MRS
First Name:KANDY
Middle Name:SUE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANDY
Other - Middle Name:SUE
Other - Last Name:INMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4006 HIGHMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4976
Mailing Address - Country:US
Mailing Address - Phone:972-412-0854
Mailing Address - Fax:
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2096
Practice Address - Country:US
Practice Address - Phone:214-820-2806
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX590005363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care