Healthcare Provider Details

I. General information

NPI: 1407388465
Provider Name (Legal Business Name): ELYSIA L STONEM MSN, AG-ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELYSIA LYNN COOK NP

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MON HEALTH DRIVE
MORGANTOWN WV
26505-2853
US

IV. Provider business mailing address

14624 11TH AVE SW
BURIEN WA
98166-1802
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax: 337-943-0846
Mailing address:
  • Phone: 304-413-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5017720
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024174282
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number96841
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61144182
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001239593
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: