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Organization
AVALON MEDICAL GROUP
Active
Organization
AVALON MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHERINE K STANLEY ARNP-BC (AUTHORIZED AGENT)
(850) 485-7341
Entity
Organization
Contact information
Practice address
1900 SUMMIT BLVD, PENSACOLA, FL 32503-3359
(850) 436-5900
Mailing address
PO BOX 10209, PENSACOLA, FL 32524-0209
(850) 476-4200
(866) 684-0566
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001078000
—
FL
01
—
00A0P
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
Enumeration date
03/01/2008
Last updated
07/06/2012
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