MS. KIMBERLY MARIE STACK (NPI# 1366413536) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366413536 |
| Entity Type | Individual |
| Full Name | MS. KIMBERLY MARIE STACK |
| Other Name | MRS. KIMBERLY MARIE MORAVEK |
| Credential | PMHNP-BC |
| Practice Address |
1758 Union St Schenectady NY 12309-6314 |
| Practice Telephone | 5189821274 |
| Practice Fax Number | 5189821277 |
| Mailing Telephone | 5189821274 |
| Mailing Fax Number | 5189821277 |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2017-11-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | F402216 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 364SP0810X |
Clinical Nurse Specialist Specialization: Psych/Mental Health, Child & Family |
F402216 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| N | 367500000X | Nurse Anesthetist, Certified Registered | 0001125389 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 367500000X | Nurse Anesthetist, Certified Registered | 426056-1 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1758 UNION ST |
| City | SCHENECTADY |
| State | NY |
| Zip Code | 12309-6314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841522950 | Asha Bammi Evans | Contractor | 1758 Union St, Schenectady, NY 12309-6314 | 2010-02-01 |
| 1699931907 | Kimberly Callan | Licensed Practical Nurse | 1758 Union St, Schenectady, NY 12309-6314 | 2008-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154973071 | Albany Med Niskayuna Ambulatory Endoscopy and Surgery Center | Clinic/Center | 1769 Union Street, 3rd Floor, Niskayana, NY 12309 | 2019-07-11 |
| 1902396351 | Erica S Hill | Occupational Therapist | 2246 Van Rensselaer Dr, Niskayuna, NY 12309 | 2018-05-11 |
| 1588107015 | Orthopedicsny, LLP | Orthopaedic Surgery | 1760 Union St, Suite 100, Schenectady, NY 12309 | 2016-12-01 |
| 1932589983 | Patricia P Primomo | Dentist | 2310 Nott Street East, Niskayuna, NY 12309 | 2015-06-04 |
| 1386074268 | Bernard P Kinlan | Social Worker | 1 Ascot Lane, Terrace At Glen Eddy, Niskayuna, NY 12309 | 2013-11-14 |
| 1255680344 | Rudy Nydegger Phd, Abpp, Pllc | Psychologist | 2317 Balltown Rd., Suite 203, Schenectady, NY 12309 | 2012-09-05 |
| 1407104094 | Rachelle Ann Kehoe | Specialist | 950 St. David's Lane, Schenectady, NY 12309 | 2012-08-29 |
| 1073882726 | Kristina Lynn Deangelo | Speech-Language Pathologist | 1872 Hexam Road West, Niskayuna, NY 12309 | 2011-12-27 |
| 1467720136 | Jjm Chiropractic, LLC | Chiropractor | 1756 Union St., Niskayuna, NY 12309 | 2011-12-08 |
| 1659658474 | Richard W Glover | Dentist | 2310 Nott St. East, Niskayuna, NY 12309 | 2011-11-08 |
| Find all providers in zip 12309 | ||||
| Taxonomy Code | 364SP0810X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Psych/Mental Health, Child & Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023366192 | Catherine May Shea | Clinical Nurse Specialist | 100 Washington St, Elmira, NY 14901-2849 | 2012-08-21 |
| City | SCHENECTADY |
| Zip Code | 12309 |
Please comment or provide details below to improve the information on MS. KIMBERLY MARIE STACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.