Glenn M Stanley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

102083 Issued in NC

Practice address

420 Owen Dr
Fayetteville, NC 28304-3430

Phone

(910) 484-1210

Fax

(910) 484-1347

NPI assigned

Oct 4, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Cross Creek Urgent Care and Family Clinic

  • Military Health Care Provider
  • Fayetteville, NC
  • NPI 1174581235
  NPD Authorized official
• Medics Primary and Urgent Care PC

  • Primary Care Clinic/Center
  • Fayetteville, NC
  • NPI 1689096349
  Medicare reassignment
• Henderson Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Henderson, NC
  • NPI 1841295904
  NPD (past)
• Medex Urgent Care, PA

  • Primary Care Clinic/Center
  • Fayetteville, NC
  • NPI 1770532897
  NPD (past)

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487548800000",
    "number": "1770570822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7169 GOLDSBORO RD",
            "city": "WADE",
            "state": "NC",
            "postal_code": "283958959",
            "telephone_number": "910-717-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043430",
            "telephone_number": "910-484-1210",
            "fax_number": "910-484-1347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANLEY",
        "first_name": "GLENN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2017-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nekiah Stanfield
• Monica Renee Stanford, LPC
• Wendy Stanford, ARDMS
• Christopher Stang, D.O.
• Latosha Marie Stanley-Brown
• Sharon Mann Stanley, FNP-C
• Shataybia Lyzell Stanley, LCSWA
• Howard Stansberry, MD
• Donna Dyer Staples, PHYSICAL THERAPY AS
• Leslie Stapleton

• Physician Assistant in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.