Individual
MRS. KIMBERLY M STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
285 IVIE LN, MANTACHIE, MS 38855-9764
(662) 282-4197
(662) 282-5121
Mailing address
280 FERGUSON LAKE RD, MARIETTA, MS 38856-6068
(662) 401-3066
(662) 842-4330
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R858096
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05838803
—
MS
Enumeration date
03/12/2013
Last updated
10/23/2014
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