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NPI Code Detail

MEDICARE: LUKE KLUMPP PA-C, AT

MEDICARE: LUKE KLUMPP PA-C, AT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant
2363A00000XPhysician AssistantPA01704RI
32255A2300XAthletic Trainer

General Provider Information

NPI Number : 1881051902
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUKE KLUMPP PA-C, AT
Provider Business Mailing Address
First Line : 455 TOLL GATE RD
Second Line : PRC AND CREDENTIALING
City : WARWICK
State : RI
Zip : 02886-2759
Country : US
Telephone Number : 401-273-0641
Fax Number : 401-273-2919
Provider Business Practice Location Address
First Line : 455 TOLL GATE RD
Second Line :
City : WARWICK
State : RI
Zip : 02886-2759
Country : US
Telephone Number : 401-729-2800
Fax Number : 401-729-2877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2016
Last Update Date : 12/16/2025

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Directions to “ LUKE KLUMPP PA-C, AT” Practice Location

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