Provider Demographics
NPI:1407070659
Name:SUMPTER, MICHELE R (CAC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:R
Last Name:SUMPTER
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1151
Mailing Address - Country:US
Mailing Address - Phone:502-644-3536
Mailing Address - Fax:
Practice Address - Street 1:1553 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1151
Practice Address - Country:US
Practice Address - Phone:502-644-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYACU017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist