Provider Demographics
NPI:1609854587
Name:STUMP, TERESA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LYNN
Last Name:STUMP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 ISLAND FORD RD
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-8735
Mailing Address - Country:US
Mailing Address - Phone:828-428-0917
Mailing Address - Fax:
Practice Address - Street 1:137 ISLAND FORD RD
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-8735
Practice Address - Country:US
Practice Address - Phone:828-428-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916481Medicaid
NC5916481Medicaid