Healthcare Provider Details

I. General information

NPI: 1245003656
Provider Name (Legal Business Name): NIKKI LAUREN STONE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE GALLEGOS

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15414 WELDIN DR
WOODBRIDGE VA
22193-1054
US

IV. Provider business mailing address

15414 WELDIN DR
WOODBRIDGE VA
22193-1054
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-9222
  • Fax:
Mailing address:
  • Phone: 703-249-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC009778
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024188839
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033573
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001295366
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95132433
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500007826
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: