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General NPI Number Information
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NPI Number | 1205776705
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Entity Type | Individual
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Provider Name | KELLY STACKHOUSE RN
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Gender | Female
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 1201 15TH ST NW STE 410
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City | WASHINGTON
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State | DC
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Zip | 20005-2899
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Country | US
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Telephone | 914-821-8993
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 KEARNEY ST
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City | DENVER
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State | CO
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Zip | 80207-1320
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Country | US
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Telephone | 617-538-4131
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0200X
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Taxonomy Name | Oncology Registered Nurse
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License Number | 1634000
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License Number State | CO
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