Provider Demographics
NPI:1033767207
Name:STELLY, CHRISTINA KAYE (RN, DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KAYE
Last Name:STELLY
Suffix:
Gender:F
Credentials:RN, DNP, PMHNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:KAYE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 CENTER AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4657
Mailing Address - Country:US
Mailing Address - Phone:708-553-2335
Mailing Address - Fax:
Practice Address - Street 1:150 MUIR RD BLDG 24
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-372-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX821169163W00000X
CA95100961163W00000X
IL041.469080163W00000X
CA95022231363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse