# AVALON MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558531905
- **Authorized official:** MS. KATHERINE K STANLEY ARNP-BC (AUTHORIZED AGENT)
- **Authorized official phone:** (850) 485-7341

## Contact information

- **Practice address:** 1900 SUMMIT BLVD, PENSACOLA, FL 32503-3359
- **Practice address phone:** (850) 436-5900
- **Mailing address:** PO BOX 10209, PENSACOLA, FL 32524-0209
- **Mailing address phone:** (850) 476-4200
- **Mailing address fax:** (866) 684-0566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/01/2008
- **Last updated:** 07/06/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001078000 | — | FL |
| 01 | — | 00A0P | BLUE CROSS BLUE SHIELD OF FLORIDA | FL |