Kimberly Marie Stack, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

402216 Issued in NY

Practice address

954 Route 146 Ste 3
Clifton Park, NY 12065-3639

Phone

(518) 952-4000

Fax

(833) 974-2234

NPI assigned

Jan 27, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Mrs. Kimberly Marie Moravek Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CDEHDD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kimberly M Stack, NP in Psychiatry PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Clifton Park, NY
  • NPI 1235929621
  NPD Authorized official
• Tammy J Leblanc NP Psychiatry PC

  • Nurse Practitioner
  • Niskayuna, NY
  • NPI 1104186717
  NPD (past)
• Tearle Ashby LCSW PC

  • Clinical Social Worker
  • Niskayuna, NY
  • NPI 1578837589
  NPD (past)
• Southeast Anesthesiology Consultants of Virginia, PLLC

  • Anesthesiology Physician
  • Norfolk, VA
  • NPI 1033242235
  NPD (past)
• Southeast Pain & Spine Care Specialists, LLC

  • Interventional Pain Medicine Physician
  • Norfolk, VA
  • NPI 1558179689
  NPD (past)
• Virginia Anesthesia and Perioperative Care Specialists LLC

  • Anesthesiology Physician
  • Newport News, VA
  • NPI 1760417281
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1366413536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "954 ROUTE 146 STE 3",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653639",
            "telephone_number": "518-952-4000",
            "fax_number": "833-974-2234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 ROUTE 146 STE 3",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653639",
            "telephone_number": "518-952-4000",
            "fax_number": "833-974-2234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "KIMBERLY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F402216",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0001125389",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "426056-1",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "402216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "MORAVEK",
            "middle_name": "MARIE",
            "prefix": "MRS.",
            "credential": "RN, CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• St. Peter'S Health Partners Medical Associates, P.C.
• St. Peter'S Health Partners Medical Associates, P.C.
• St. Peter'S Health Partners Medical Associates, P.C.
• Gregg R St.Clair, L.AC.
• Cathern St.George
• Marcin Standa
• Jeff Corey Starr, O.D.
• Nancy Starr, O.D.
• Suzanne Lyn Steimer-Wolfe, LPN
• Jason Harrison Steindler, DO

• Psychiatric/Mental Health Nurse Practitioner in Clifton Park, NY
• Providers in Clifton Park, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.