Provider Demographics
NPI:1679346977
Name:STANLEY, MADISON CLAIRE (FNP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:CLAIRE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3519
Mailing Address - Country:US
Mailing Address - Phone:423-667-8601
Mailing Address - Fax:
Practice Address - Street 1:1276 GILBREATH DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-6503
Practice Address - Country:US
Practice Address - Phone:423-439-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000035008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily