Provider Demographics
NPI:1104130178
Name:STINSON, KELLY NICOLE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:STINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DARTMOUTH DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NH
Mailing Address - Zip Code:03032-3982
Mailing Address - Country:US
Mailing Address - Phone:781-572-2759
Mailing Address - Fax:
Practice Address - Street 1:15 DARTMOUTH DR UNIT 102
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NH
Practice Address - Zip Code:03032-3982
Practice Address - Country:US
Practice Address - Phone:781-572-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00606552084P0800X
CT0672612084P0800X
NE268022084P0800X
OHACKNOWLEDGMENTLETTER2084P0800X
NH239002084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry