MEDICARE: DR. KRISTI KAYE SUMPTER D.O.

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
1	208600000X	Surgery Physician	L0630	TX
2	2086S0122X	Plastic and Reconstructive Surgery Physician	L0630	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8H4710	OTHER		BCBS

General Provider Information

NPI Number	:	1366540932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTI KAYE SUMPTER D.O.

Provider Business Mailing Address
First Line	:	12827 JONES RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4605
Country	:	US
Telephone Number	:	281-894-9990
Fax Number	:	281-894-9993

Provider Business Practice Location Address
First Line	:	12827 JONES RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4605
Country	:	US
Telephone Number	:	281-894-9990
Fax Number	:	281-894-9993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2011

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