Individual
MISS KIMBERLY ANN STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
277 NJ - 70, TOMS RIVER, NJ 08755
(212) 516-2300
Mailing address
346 KINGSLAND AVE, LYNDHURST, NJ 07071-2734
(201) 394-4266
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
26NJ15212300
NJ
363LG0600X
Gerontology Nurse Practitioner
Primary
26NJ15212300
NJ
Other
Enumeration date
02/27/2025
Last updated
08/11/2025
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