Provider Demographics
NPI:1386936946
Name:STOCKTON-DRUM, KELLY JO (ANP-C,GNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:STOCKTON-DRUM
Suffix:
Gender:F
Credentials:ANP-C,GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-9715
Mailing Address - Country:US
Mailing Address - Phone:828-466-0466
Mailing Address - Fax:828-466-8862
Practice Address - Street 1:3975 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658
Practice Address - Country:US
Practice Address - Phone:828-466-0466
Practice Address - Fax:828-466-8862
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005167363L00000X, 363LG0600X, 363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004895Medicaid
NC203866OtherRN LICENSE
NC5005167OtherNP LICESNE
NC19N0HOtherBCBS
NCMS2385549OtherDEA