Provider Demographics
NPI:1417261934
Name:STOOPS, KYRSTEN E (MD)
Entity Type:Individual
Prefix:
First Name:KYRSTEN
Middle Name:E
Last Name:STOOPS
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 642302
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99164
Mailing Address - Country:US
Mailing Address - Phone:253-403-2938
Mailing Address - Fax:253-403-2968
Practice Address - Street 1:1125 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164
Practice Address - Country:US
Practice Address - Phone:253-403-2938
Practice Address - Fax:253-403-2968
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD.60298970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program