Provider Demographics
NPI:1538933981
Name:STUMP, KATIE REBECCA (CRNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:REBECCA
Last Name:STUMP
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN
Mailing Address - State:PA
Mailing Address - Zip Code:17018-9764
Mailing Address - Country:US
Mailing Address - Phone:814-441-0085
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-6523
Practice Address - Fax:570-271-8056
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028632363LC0200X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology