Provider Demographics
NPI:1548423486
Name:STOKES, KELLY R (CRNA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:STOKES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:R
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57101-0848
Mailing Address - Country:US
Mailing Address - Phone:605-339-6525
Mailing Address - Fax:605-339-2905
Practice Address - Street 1:600 N SIOUX POINT RD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5000
Practice Address - Country:US
Practice Address - Phone:605-242-7246
Practice Address - Fax:605-242-3474
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD108426367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00734599Medicare PIN
IAI0923078Medicare PIN