MEDICARE: MR. STANLEY KURLEY JR. PA-C, ATC

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	2255A2300X	Athletic Trainer	0526	AZ
2	363A00000X	Physician Assistant	5088	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891751574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STANLEY KURLEY JR. PA-C, ATC

Provider Business Mailing Address
First Line	:	PO BOX 4000
Second Line	:	ROUTE 264 MILE POST 388
City	:	POLACCA
State	:	AZ
Zip	:	86042-4000
Country	:	US
Telephone Number	:	928-737-6000
Fax Number	:	928-737-6080

Provider Business Practice Location Address
First Line	:	HIGHWAY 264 MILE POST 388
Second Line	:
City	:	POLACCA
State	:	AZ
Zip	:	86042-4000
Country	:	US
Telephone Number	:	928-737-6000
Fax Number	:	928-737-6080

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	10/23/2013

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Directions to “ MR. STANLEY KURLEY JR. PA-C, ATC” Practice Location

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