Provider Demographics
NPI:1902490816
Name:STUMBO, BRITTANY M
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:M
Last Name:STUMBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24070 COAL HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:188 GALAXY ST
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:WV
Practice Address - Zip Code:24853-7725
Practice Address - Country:US
Practice Address - Phone:304-887-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker