Provider Demographics
NPI:1366770315
Name:STANLEY, CASSIE JO (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:JO
Last Name:STANLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1194
Mailing Address - Country:US
Mailing Address - Phone:606-784-6641
Mailing Address - Fax:606-780-2382
Practice Address - Street 1:234 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1194
Practice Address - Country:US
Practice Address - Phone:606-784-6641
Practice Address - Fax:606-780-2382
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006278363LF0000X, 363L00000X
KY6278P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100235040Medicaid
P100033601Medicare PIN