Provider Demographics
NPI:1346249836
Name:STULTZ, DEBRA (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:STULTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-0457
Mailing Address - Country:US
Mailing Address - Phone:304-733-5380
Mailing Address - Fax:304-733-5796
Practice Address - Street 1:6171 CHILDERS RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1227
Practice Address - Country:US
Practice Address - Phone:304-733-5380
Practice Address - Fax:304-733-5796
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV166722084P0800X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0115698000Medicaid
1346249836OtherHEALTHNET/TRICARE
134634936OtherMSBCBS
1346248936OtherMHNET
WV4510542OtherAETNA
1061788OtherCIGNA BEHAVIORAL HEALTH
271667227OtherCARELINK/COVENTRY
1346249836OtherUNITED BEHAVIORAL HEALTH
271667227Other4-MOST
WV3810018468Medicaid
1346249836OtherHUMANA
271667227OtherWELLS FARGO (PEIA)
WV0115698000Medicaid
WV3810018468Medicaid
134634936OtherMSBCBS