Provider Demographics
NPI:1114445590
Name:STANDLEY, MARK A (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:STANDLEY
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Gender:
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 W 21ST ST
Practice Address - Street 2:SAME DAY CARE CLINIC - CLOVIS
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-2011
Practice Address - Country:US
Practice Address - Phone:505-769-7577
Practice Address - Fax:505-769-6374
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2025-04-08
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Provider Licenses
StateLicense IDTaxonomies
NMPA2018-0080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant