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NPI Code Detail

MEDICARE: TREVOR STANLEY NP

MEDICARE: TREVOR STANLEY NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LC0200XCritical Care Medicine Nurse Practitioner106397WV

General Provider Information

NPI Number : 1417886953
Entity Type Code : Individual
Provider Name (Legal Business Name) : TREVOR STANLEY NP
Provider Business Mailing Address
First Line : 4619 KANAWHA AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1319
Country : US
Telephone Number : 304-400-4545
Fax Number : 304-400-4546
Provider Business Practice Location Address
First Line : 4619 KANAWHA AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1319
Country : US
Telephone Number : 304-400-4545
Fax Number : 304-400-4546
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2026
Last Update Date : 05/19/2026

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