MEDICARE: ETHAN STANLEY

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
1	363LF0000X	Family Nurse Practitioner	AP139269	TX

General Provider Information

NPI Number	:	1427529338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN STANLEY

Provider Business Mailing Address
First Line	:	8528 DAVIS BLVD STE 150
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-8369
Country	:	US
Telephone Number	:	817-242-2630
Fax Number	:	512-782-9316

Provider Business Practice Location Address
First Line	:	8528 DAVIS BLVD STE 150
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-8369
Country	:	US
Telephone Number	:	817-242-2630
Fax Number	:	512-782-9316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	07/12/2021

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Directions to “ ETHAN STANLEY ” Practice Location

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