Provider Demographics
NPI:1639331895
Name:STUMP, KEVIN JOSEPH (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSEPH
Last Name:STUMP
Suffix:
Gender:M
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22325 GOSLING RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4409
Mailing Address - Country:US
Mailing Address - Phone:281-724-7980
Mailing Address - Fax:281-746-6268
Practice Address - Street 1:22325 GOSLING RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-4409
Practice Address - Country:US
Practice Address - Phone:281-724-7980
Practice Address - Fax:281-746-6268
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688758163W00000X
TXAP116770363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily