Provider Demographics
NPI:1518922913
Name:SUMPTER, STACY LYNN (DNP-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:SUMPTER
Suffix:
Gender:F
Credentials:DNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 N 1400 W
Mailing Address - Street 2:SUITE # 19
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7301
Mailing Address - Country:US
Mailing Address - Phone:435-688-0759
Mailing Address - Fax:435-656-0491
Practice Address - Street 1:292 S 1470 E STE 200
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1764
Practice Address - Country:US
Practice Address - Phone:435-688-0759
Practice Address - Fax:435-656-0491
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60776444408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ78149Medicare UPIN