Provider Demographics
NPI:1144082157
Name:STELLY, JESSICA KYER (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KYER
Last Name:STELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-0008
Mailing Address - Country:US
Mailing Address - Phone:505-285-2726
Mailing Address - Fax:
Practice Address - Street 1:400 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2739
Practice Address - Country:US
Practice Address - Phone:050-285-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76934163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse