Active NPI
Jacqueline Howard Stump, D.D.S.
- General Practice Dentistry
- Charleston, WV
National Provider Identifier
1700147477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3990
- Practice address
- 1321 Virginia St E Ste 1
Charleston, WV 25301-3053 - Phone
- (304) 343-8805
- Fax
- (304) 343-8806
- NPI assigned
- May 30, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3990 | WV | Primary |
Addresses
Primary practice location
1321 Virginia St E Ste 1
Charleston, WV 25301-3053
Mailing address
1321 Virginia St E Ste 1
Charleston, WV 25301-3053
Phone (304) 343-8805
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3990 | WV | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338336000000",
"number": "1700147477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1321 VIRGINIA ST E STE 1",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253013053",
"telephone_number": "304-343-8805",
"fax_number": "304-343-8806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1321 VIRGINIA ST E STE 1",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253013053",
"telephone_number": "304-343-8805",
"fax_number": "304-343-8806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUMP",
"first_name": "JACQUELINE",
"middle_name": "HOWARD",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-30",
"last_updated": "2012-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WV",
"license": "3990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.