Individual
MS. KIMBERLY MARIE STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
954 ROUTE 146 STE 3, CLIFTON PARK, NY 12065-3639
(518) 952-4000
(833) 974-2234
Mailing address
954 ROUTE 146 STE 3, CLIFTON PARK, NY 12065-3639
(518) 952-4000
(833) 974-2234
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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