Provider Demographics
NPI:1316283096
Name:STAWARSKI, KAKELLY (RN)
Entity type:Individual
Prefix:
First Name:KAKELLY
Middle Name:
Last Name:STAWARSKI
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 1:2241 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-3617
Mailing Address - Country:US
Mailing Address - Phone:806-440-0271
Mailing Address - Fax:
Practice Address - Street 1:2241 CHARLES ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-3617
Practice Address - Country:US
Practice Address - Phone:806-440-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX825359163WH1000X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WH1000XNursing Service ProvidersRegistered NurseHospice