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NPI Code Detail

MEDICARE: JENNIFER LYNN STANLEY MD

MEDICARE:   JENNIFER LYNN STANLEY  MD
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
1207Q00000XFamily Medicine Physician01051065AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P00714997OTHERINRAILROAD INDIVIDUAL
3DC3600OTHERINRAILROAD GROUP

General Provider Information

NPI Number : 1114900974
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN STANLEY MD
Provider Business Mailing Address
First Line : 301 HENRY ST
Second Line :
City : NORTH VERNON
State : IN
Zip : 47265-1030
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 HENRY ST
Second Line :
City : NORTH VERNON
State : IN
Zip : 47265-1030
Country : US
Telephone Number : 812-352-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2005
Last Update Date : 08/04/2022

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Directions to “ JENNIFER LYNN STANLEY MD” Practice Location

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