Individual provider Active NPI

Trevor Stanley, NP

  • Critical Care Medicine Nurse Practitioner
  • South Charleston, WV
National Provider Identifier
1417886953
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine Nurse PractitionerTaxonomy code 363LC0200X
License
106397 Issued in WV
Practice address
4619 Kanawha Ave SW
South Charleston, WV 25309-1319
Phone
(304) 400-4545
Fax
(304) 400-4546
NPI assigned
May 19, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Nurse Practitioner 363LC0200X 106397 WV Primary

Addresses

Primary practice location

4619 Kanawha Ave SW
South Charleston, WV 25309-1319

Mailing address

4619 Kanawha Ave SW
South Charleston, WV 25309-1319
Phone (304) 400-4545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260625000097 WV Practitioner - Nurse Practitioner 9133692700 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2026
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
THS Physician Partners IncGroup PAC ID 9537316393, 366 clinicians

Practice addresses (Care Compare)

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
106397WVMDCritical Care Medicine Nurse Practitioner

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1779148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1417886953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4619 KANAWHA AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091319",
            "telephone_number": "304-400-4545",
            "fax_number": "304-400-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4619 KANAWHA AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091319",
            "telephone_number": "304-400-4545",
            "fax_number": "304-400-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANLEY",
        "first_name": "TREVOR",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-05-19",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "WV",
            "license": "106397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.