Tricia L Stanley, NURSE PRACTITIONER

Individual provider Active NPI Nurse Practitioner · Crawfordsville, IN

NPI 1376578435 · NPPES record last updated Sep 8, 2022

Key facts

NPI
1376578435
Entity type
Individual (NPI type 1)
Primary specialty
Nurse Practitioner 363L00000X
License
71000752 (IN)
Practice address
1615 US Hwy 231 S
Suite a
Crawfordsville, IN 47933-4603
Phone
(765) 323-4689
NPI assigned
Jul 11, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71000752INMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Athens Medical Group, Inc Past
since May 26, 2009
Accepting new patients
Proactive Mso, LLC Past
since Apr 24, 2022
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71000752 IN Yes

Addresses

Primary practice location

1615 US Hwy 231 S
Suite a
Crawfordsville, IN 47933-4603

Mailing address

1615 US Hwy 231 S
Suite a
Crawfordsville, IN 47933-4603
Phone (765) 323-4689

Other providers in Crawfordsville, IN

All providers in Crawfordsville, IN · Nurse Practitioner in Indiana

Sources for this page

Verify at the official NPI Registry.