Individual
TIMOTHY KYLE STACKS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 BREWSTER BLVD, NAVAL HOSPITAL CAMP LEJEUNE, CAMP LEJEUNE, NC 28547-2538
(910) 450-4791
Mailing address
100 DOCKSIDE DR, JACKSONVILLE, NC 28546-9768
(910) 353-7509
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
149855
NC
Other
Enumeration date
02/14/2006
Last updated
07/08/2007
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