Provider Demographics
NPI:1710119847
Name:STUMP, JENNA LYNN (PA)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LYNN
Last Name:STUMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:LYNN
Other - Last Name:AHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6227 FRANKFORT HWY
Mailing Address - Street 2:
Mailing Address - City:BENZONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49616-8632
Mailing Address - Country:US
Mailing Address - Phone:231-882-9661
Mailing Address - Fax:231-882-9616
Practice Address - Street 1:2283 E M 113
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649-9370
Practice Address - Country:US
Practice Address - Phone:231-263-0700
Practice Address - Fax:231-263-0707
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant