Provider Demographics
NPI:1053077198
Name:STONE, KERRI
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:L
Other - Last Name:HACKLER HENVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7910 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5533
Mailing Address - Country:US
Mailing Address - Phone:317-355-3200
Mailing Address - Fax:317-355-3201
Practice Address - Street 1:7910 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5533
Practice Address - Country:US
Practice Address - Phone:317-355-3200
Practice Address - Fax:317-355-3201
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28197193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner