Provider Demographics
NPI:1336424399
Name:STUMPF, KIMBERLY ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:STUMPF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 FEDERAL ST
Mailing Address - Street 2:SUITE 2302
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5749
Mailing Address - Country:US
Mailing Address - Phone:563-324-9695
Mailing Address - Fax:
Practice Address - Street 1:736 FEDERAL ST
Practice Address - Street 2:SUITE 2302
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5749
Practice Address - Country:US
Practice Address - Phone:563-324-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist