=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861728909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRISTY STUMB APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2009
-----------------------------------------------------
Last Update Date | 10/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 619 N. MAIN ST
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-489-7256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 236 DIXON SPRINGS HWY
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37030-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-489-7256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 11015441
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 845253
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 204968
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 0024182563
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 14465
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 0003265
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 4704380501
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 3016443
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------