Provider Demographics
NPI:1982926184
Name:STONER, DOROTHY KAY (NPC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:KAY
Last Name:STONER
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 KOKOPELLI BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-8723
Mailing Address - Country:US
Mailing Address - Phone:970-639-9505
Mailing Address - Fax:970-639-2993
Practice Address - Street 1:456 KOKOPELLI BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-8723
Practice Address - Country:US
Practice Address - Phone:970-639-9505
Practice Address - Fax:970-639-2993
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57021287Medicaid