Healthcare Provider Details

I. General information

NPI: 1265034615
Provider Name (Legal Business Name): NEKIA STANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9894 E 121ST ST
FISHERS IN
46037-4154
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-6060
  • Fax:
Mailing address:
  • Phone: 317-621-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71010551A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: