DR. JOHN D STULL (NPI# 1649359068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649359068 |
| Entity Type | Individual |
| Full Name | DR. JOHN D STULL |
| Credential | MD |
| Practice Address |
12607 Se Mill Plain Blvd Vancouver WA 98684-6055 |
| Mailing Address |
3227 Nw Spencer St Portland OR 97229-8054 |
| Practice Telephone | 3604186001 |
| Mailing Telephone | 5032974758 |
| Enumeration Date | 2006-11-05 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | MD20903 | OR | Allopathic & Osteopathic Physicians |
| Y | 208000000X | Pediatrics | MD00020064 | WA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700987336 | John K Stull | Chiropractor | 2224 Woodman Dr, Kettering, OH 45420-1370 | 2006-09-26 |
| 1295097640 | John C Stull | Technician, Other | 1332 Upland Dr, Houston, TX 77043-4719 | 2012-06-12 |
| 1457492829 | John H.m. Stull II | Dentist | 19426 Leitersburg Pike, Hagerstown, MD 21742-1438 | 2007-02-09 |
| Street Address |
12607 SE MILL PLAIN BLVD |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98684-6055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659340735 | Richard M Shuey | Psychiatry & Neurology | 12607 Se Mill Plain Blvd, Vancouver, WA 98684-6055 | 2006-03-14 |
| 1447883020 | Kendra M Latimer | Case Manager/Care Coordinator | 12607 Se Mill Plain Blvd, Vancouver, WA 98684 | 2020-02-21 |
| 1285273086 | Leayn N Vandeven | Student in an Organized Health Care Education/Training Program | 12607 Se Mill Plain Blvd, Vancouver, WA 98684-6055 | 2019-12-27 |
| 1528605342 | Jeff Cooksey | Student in an Organized Health Care Education/Training Program | 12607 Se Mill Plain Blvd, Vancouver, WA 98684-6055 | 2019-12-01 |
| 1104461961 | Fidel Hernandez Jr. | Nurse Practitioner | 12607 Se Mill Plain Blvd, Vancouver, WA 98684-6055 | 2019-11-15 |
| 1518516822 | Tameca Vernee Pryce | Respiratory Therapist, Certified | 12607 Se Mill Plain Blvd, Vancouver, WA 98684-6055 | 2019-09-09 |
| 1700348042 | Beredu Abraham Geleto | Registered Nurse | 12607 Se Mill Plain Blvd, Vancouver, WA 98684-6055 | 2019-04-04 |
| 1942772660 | Patricia Maria Rivera | Psychologist | 12607 Se Mill Plain Blvd, Vancouver, WA 98684-6055 | 2018-12-19 |
| 1992288328 | Irene Moulton | Pharmacist | 12607 Se Mill Plain Blvd, Vancouver, WA 98684-6055 | 2018-09-12 |
| 1962982348 | Christina Kirkpatrick | Student in an Organized Health Care Education/Training Program | 12607 Se Mill Plain Blvd, Vancouver, WA 98684-6055 | 2018-08-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285291849 | Pacifica Sylvan Park LLC | Alzheimer Center (Dementia Center) | 2400 Ne 112th Avenue, Vancouver, WA 98684 | 2019-05-20 |
| 1699242826 | Heidi Ericka Jackson | Registered Nurse | 15606 Ne 12th Way, Vancouver, WA 98684 | 2018-10-25 |
| 1477076727 | Brian Benasa Bardeloza | Dentist | 605 Se 164th Ave Ste 103, Vancouver, WA 98684 | 2017-07-19 |
| 1992226062 | Judith Moreno-castro | Massage Therapist | 2501 Ne 138th Ave., #60, Vancouver, WA 98684 | 2017-06-29 |
| 1346790706 | Samuel Joonsang Lee | Registered Nurse | 501 Se 172nd Ave Ste 210, Vancouver, WA 98684 | 2016-10-10 |
| 1912353178 | Cheryl A. Hamilton-jefferson | Counselor | 11818 Se Mill Plain Blvd Ste 311g, Vancouver, WA 98684 | 2016-05-06 |
| 1063866424 | Kim Forgione | Optometrist | 1900 Ne 162nd Ave Ste D103, Vancouver, WA 98684 | 2016-04-21 |
| 1700254257 | Desiree Haggart | Registered Nurse | 406 Se 131st St., Suite A101, Vancouver, WA 98684 | 2015-09-14 |
| 1215318068 | Paige M. King | Behavioral Analyst | 11818 Se Mill Plain Blvd Ste 203, Vancouver, WA 98684 | 2015-06-17 |
| 1417354366 | Amanda Hilkey, Lmp | Massage Therapist | 108 Se 24th Ave, Ste 9, Vancouver, WA 98684 | 2014-11-20 |
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| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710490545 | Jessica Lynn Jacoby | Pediatrics | 2404 Ne 187th Pl, Vancouver, WA 98684-6448 | 2017-11-15 |
| 1891215109 | Khalid Taha | Pediatrics | 4480 Oak Street, K4-151, Bc Children's Hospital, Vancouver, BRITISH COLUMBIA V6H 3V4 | 2017-06-27 |
| 1265798821 | Paul Joshua Goodwin | Pediatrics | 505 Ne 87th Ave Ste 120, Evergreen Pediatrics Clinic, Vancouver, WA 98664-1965 | 2012-04-09 |
| 1265722342 | Calvin Clayton Clark | Pediatrics | 6701 Se Evergreen Hwy, Vancouver, WA 98661 | 2011-04-11 |
| 1598977209 | Jason Daniel Wister | Pediatrics | 400 Northeast Mother Joseph Place, Vancouver, WA 98664 | 2007-05-04 |
| 1578589784 | Stacy Lynn Drasen | Pediatrics | 501 Se 172nd Ave Ste 150, Vancouver, WA 98684-9542 | 2006-07-14 |
| 1194704445 | Jean Marie Haggerty | Pediatrics | 7101 Ne 137th Ave Ofc, Vancouver, WA 98682-4933 | 2006-01-14 |
| 1104177450 | Megan M Klenow | Pediatrics | 2211 Ne 139th St, Vancouver, WA 98686-2742 | 2012-09-26 |
| 1043536980 | Jing Jing Wang | Pediatrics | 700 Ne 87th Ave, Vancouver, WA 98664-1913 | 2010-04-16 |
| 1396931523 | Lijuan Leslie Yu | Pediatrics | 11719 Ne 95th St, #f, Vancouver, WA 98682-2444 | 2007-09-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.