Provider Demographics
NPI:1093133654
Name:STUMP, AMY (NP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:STUMP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 4TH AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2878
Mailing Address - Country:US
Mailing Address - Phone:308-698-0581
Mailing Address - Fax:
Practice Address - Street 1:4111 4TH AVENUE
Practice Address - Street 2:SUITE 50
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845
Practice Address - Country:US
Practice Address - Phone:308-698-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111422363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology