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1447224936
TIMOTHY KYLE STACKS
CAMP LEJEUNE, NC
NPI
1447224936
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
367500000X Nurse Anesthetist, Certified Registered
(Licence: NC 149855)
Enumeration Date
2006-02-14
Last Update Date
2007-07-08
Business Address
-- TIMOTHY KYLE STACKS CRNA
100 BREWSTER BLVD NAVAL HOSPITAL CAMP LEJEUNE
CAMP LEJEUNE, NC 28547-2538
Phone number: 910-450-4791
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Mailing Address
-- TIMOTHY KYLE STACKS CRNA
100 DOCKSIDE DR
JACKSONVILLE, NC 28546-9768
Phone number: 910-353-7509
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