Provider Demographics
NPI:1861728909
Name:STUMB, CRISTY (APRN)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:
Last Name:STUMB
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 DIXON SPRINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1015
Mailing Address - Country:US
Mailing Address - Phone:615-489-7256
Mailing Address - Fax:
Practice Address - Street 1:619 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030
Practice Address - Country:US
Practice Address - Phone:615-489-7256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-24
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015441363LA2100X
NV845253363LA2100X
OK204968363LA2100X
VA0024182563363LA2100X
TN14465363LA2100X
CO0003265363LA2100X
MI4704380501363LA2100X
KY3016443363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health