MEDICARE: AMY JO KUMP PAC

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	363A00000X	Physician Assistant	00964	WV

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	1689632887	OTHER		NPI

General Provider Information

NPI Number	:	1689632887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JO KUMP PAC

Provider Business Mailing Address
First Line	:	8 LEE ST
Second Line	:
City	:	MOOREFIELD
State	:	WV
Zip	:	26836-1091
Country	:	US
Telephone Number	:	304-538-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 LEE ST
Second Line	:
City	:	MOOREFIELD
State	:	WV
Zip	:	26836-1091
Country	:	US
Telephone Number	:	304-538-7707
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/28/2015

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Directions to “ AMY JO KUMP PAC” Practice Location

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