Provider Demographics
NPI:1134272529
Name:STUMBO, JULIE C (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:STUMBO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:ROOM M-50
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-218-5537
Mailing Address - Fax:859-323-8056
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:ROOM M-50
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0298
Practice Address - Country:US
Practice Address - Phone:859-218-5537
Practice Address - Fax:859-323-8056
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA927363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical