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Individual
MS. KIMBERLY MARIE STACK
Active
Individual
MS. KIMBERLY MARIE STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
F402216
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402216
NY
367500000X
Certified Registered Nurse Anesthetist
0001125389
VA
367500000X
Certified Registered Nurse Anesthetist
426056-1
NY
Other
Enumeration date
01/27/2006
Last updated
06/02/2025
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