Healthcare Provider Details

I. General information

NPI: 1770255820
Provider Name (Legal Business Name): KARSON MAKENNA STANLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 US 421 S
LILLINGTON NC
27546-6760
US

IV. Provider business mailing address

401 OBERLIN RD APT 500
RALEIGH NC
27605-1489
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-1210
  • Fax:
Mailing address:
  • Phone: 336-516-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11744
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: