Provider Demographics
NPI:1689632887
Name:KUMP, AMY JO (PAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:KUMP
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LEE ST
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1091
Mailing Address - Country:US
Mailing Address - Phone:304-538-7707
Mailing Address - Fax:
Practice Address - Street 1:8 LEE ST
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1091
Practice Address - Country:US
Practice Address - Phone:304-538-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00964363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000548Medicaid
1689632887OtherNPI
WV3810000548Medicaid
9189782Medicare PIN