Provider Demographics
NPI:1235929621
Name:KIMBERLY M STACK, NP IN PSYCHIATRY PC
Entity type:Organization
Organization Name:KIMBERLY M STACK, NP IN PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:518-952-4000
Mailing Address - Street 1:954 ROUTE 146 STE 3
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3639
Mailing Address - Country:US
Mailing Address - Phone:518-952-4000
Mailing Address - Fax:
Practice Address - Street 1:954 ROUTE 146 STE 3
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3639
Practice Address - Country:US
Practice Address - Phone:518-952-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty