1346249836 NPI number — DEBRA STULTZ M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346249836 NPI number — DEBRA STULTZ M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

STULTZ

Provider First Name:

DEBRA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1346249836

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/23/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 457

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BARBOURSVILLE

Provider Business Mailing Address State Name:

WV

Provider Business Mailing Address Postal Code:

25504-0457

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

304-733-5380

Provider Business Mailing Address Fax Number:

304-733-5796

Provider First Line Business Practice Location Address:

6171 CHILDERS RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BARBOURSVILLE

Provider Business Practice Location Address State Name:

WV

Provider Business Practice Location Address Postal Code:

25504-1227

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

304-733-5380

Provider Business Practice Location Address Fax Number:

304-733-5796

Provider Enumeration Date:

07/18/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2084P0800X , with the licence number:  16672 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2084S0012X , with the licence number: 16672 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 0115698000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 1346249836 . This is a "HEALTHNET/TRICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 134634936 . This is a "MSBCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1346248936 . This is a "MHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: 4510542 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 1061788 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 271667227 . This is a "CARELINK/COVENTRY" identifier . This identifiers is of the category "OTHER".
• Identifier: 1346249836 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 271667227 . This is a "4-MOST" identifier . This identifiers is of the category "OTHER".
• Identifier: 3810018468 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 1346249836 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
• Identifier: 271667227 . This is a "WELLS FARGO (PEIA)" identifier . This identifiers is of the category "OTHER".