Provider Demographics
NPI:1578929899
Name:STUMP, MELODY (NP-C)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:STUMP
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:MICHELLE
Other - Last Name:MAYHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7364
Mailing Address - Fax:502-568-7136
Practice Address - Street 1:109 HIGHWAY 70 N
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-4001
Practice Address - Country:US
Practice Address - Phone:423-272-3099
Practice Address - Fax:423-272-6591
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN120526163W00000X
TNAPN22055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse