Healthcare Provider Details

I. General information

NPI: 1235513540
Provider Name (Legal Business Name): JOSHUA DAVID STUMPF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SIJEN AVE
WHITEMAN AFB MO
65305-1269
US

IV. Provider business mailing address

331 SIJEN AVE
WHITEMAN AFB MO
65305-1269
US

V. Phone/Fax

Practice location:
  • Phone: 660-687-2188
  • Fax:
Mailing address:
  • Phone: 660-687-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: