Individual
DR. JESSICA RUTH STUMBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1230 MARKET ST, LA GRANGE, KY 40031-7986
(502) 225-6900
(502) 666-7693
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39532
KY
207RS0010X
Sports Medicine (Internal Medicine) Physician
39532
KY
208000000X
Pediatrics Physician
39532
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200910080
—
IN
05
—
7100061440
—
KY
Enumeration date
05/09/2007
Last updated
03/21/2025
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