Provider Demographics
NPI:1659867141
Name:STUMP, KATHERINE (PA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:STUMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:787 11TH AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3584
Mailing Address - Country:US
Mailing Address - Phone:212-367-1718
Mailing Address - Fax:
Practice Address - Street 1:787 11TH AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3584
Practice Address - Country:US
Practice Address - Phone:212-604-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical