Provider Demographics
NPI:1477588341
Name:STONE, KIMBERLY ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-456-0488
Mailing Address - Fax:214-456-4486
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9257
Practice Address - Country:US
Practice Address - Phone:214-456-0488
Practice Address - Fax:214-456-4486
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0661208000000X, 208000000X, 2080P0006X
PAMD442761208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001382000Medicaid
MDKR47J027Medicare ID - Type Unspecified
MD001382000Medicaid