Provider Demographics
NPI:1972034106
Name:STOVER, JAYDON
Entity Type:Individual
Prefix:
First Name:JAYDON
Middle Name:
Last Name:STOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CENTENNIAL DR APT 6
Mailing Address - Street 2:
Mailing Address - City:NORTH SIOUX CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57049-3139
Mailing Address - Country:US
Mailing Address - Phone:641-330-2490
Mailing Address - Fax:
Practice Address - Street 1:7828 FIR AVE
Practice Address - Street 2:
Practice Address - City:RICEVILLE
Practice Address - State:IA
Practice Address - Zip Code:50466-7039
Practice Address - Country:US
Practice Address - Phone:641-330-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program