Provider Demographics
NPI:1881487783
Name:STANLEY, TRAVIS ELCANEY (PA)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ELCANEY
Last Name:STANLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4096
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4096
Mailing Address - Country:US
Mailing Address - Phone:423-223-3658
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 4096
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-4096
Practice Address - Country:US
Practice Address - Phone:423-223-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6537363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant