Provider Demographics
NPI:1447411327
Name:STOLICA, KATHY L (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:STOLICA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:YVONNE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:304 LESTER RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-3808
Mailing Address - Country:US
Mailing Address - Phone:423-323-7052
Mailing Address - Fax:423-844-2686
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-2686
Practice Address - Fax:423-844-2688
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN163089367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I436540Medicare PIN