=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467262212
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TROY MICHAEL STUMP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 HIGH POINT CT
-----------------------------------------------------
City | MT WASHINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40047-6560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-955-6129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 HIGH POINT CT
-----------------------------------------------------
City | MT WASHINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40047-6560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 4033879
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4003879
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------