Provider Demographics
NPI:1568611036
Name:CROCKETT-STUMP, FRANCIS (CRNA)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:CROCKETT-STUMP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:FRANCIS
Other - Middle Name:
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6209
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0714
Mailing Address - Country:US
Mailing Address - Phone:304-233-2455
Mailing Address - Fax:304-233-6073
Practice Address - Street 1:3 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9316
Practice Address - Country:US
Practice Address - Phone:304-233-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46221367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered