Provider Demographics
NPI:1992393425
Name:STONE, KELLY LYNN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:STONE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-7346
Mailing Address - Country:US
Mailing Address - Phone:570-947-1719
Mailing Address - Fax:
Practice Address - Street 1:17 HAYS AVE
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795-1418
Practice Address - Country:US
Practice Address - Phone:607-761-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY616448-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse