Provider Demographics
NPI:1316576085
Name:STONE, KELLY LORRAINE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LORRAINE
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LORRAINE
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1602 ROCK PRAIRE RD.
Mailing Address - Street 2:STE. 3000
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5989
Mailing Address - Country:US
Mailing Address - Phone:979-774-3232
Mailing Address - Fax:979-690-4895
Practice Address - Street 1:1602 ROCK PRAIRIE RD STE 3000
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5989
Practice Address - Country:US
Practice Address - Phone:979-774-3232
Practice Address - Fax:979-690-4895
Is Sole Proprietor?:No
Enumeration Date:2020-04-05
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35930390200000X
TXV8408208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program