Healthcare Provider Details

I. General information

NPI: 1801774617
Provider Name (Legal Business Name): KATLYN MARIE STANLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 SANDY ROCK PL STE E
CHARLOTTE NC
28277-7731
US

IV. Provider business mailing address

4705 UNIVERSITY DR BLDG 700
DURHAM NC
27707-3489
US

V. Phone/Fax

Practice location:
  • Phone: 980-580-0468
  • Fax: 980-580-0470
Mailing address:
  • Phone: 919-237-1337
  • Fax: 866-538-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024420
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number443319
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: