Provider Demographics
NPI:1154889830
Name:STANDLEY, KERRY TIMMINS (NP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:TIMMINS
Last Name:STANDLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PRESBYTERIAN LN
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-2266
Mailing Address - Country:US
Mailing Address - Phone:252-208-7784
Mailing Address - Fax:
Practice Address - Street 1:2100 PRESBYTERIAN LN
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-2266
Practice Address - Country:US
Practice Address - Phone:252-208-7784
Practice Address - Fax:919-580-7010
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011572363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health