Basic Information
| Provider Information | |||||||||
| NPI: | 1659027142 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANLY | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | LANE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 N GEORGE RD | ||||||||
| Address2: | |||||||||
| City: | FLINTVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373355404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319934247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 207 ELK AVE S | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373343051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314332551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2022 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 31259 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.