=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346612769
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FENI STANLEY JOHN RN-FNP, AGACNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2015
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5308 N GALLOWAY AVE STE 201
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-800-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 FENWICK DR
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75182-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-203-8096
-----------------------------------------------------
Fax | 972-203-8096
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP129044
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 2021161511
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------