Healthcare Provider Details

I. General information

NPI: 1851247639
Provider Name (Legal Business Name): JO-BETH STAMM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 NEWTON RD
FAYETTEVILLE WV
25840-8015
US

IV. Provider business mailing address

232 NEWTON RD
FAYETTEVILLE WV
25840-8015
US

V. Phone/Fax

Practice location:
  • Phone: 304-719-1814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number126949
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number78792
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: