Healthcare Provider Details

I. General information

NPI: 1669083275
Provider Name (Legal Business Name): AMEDEE STOKLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 DAPHNE AVE
DAPHNE AL
36526-4298
US

IV. Provider business mailing address

25 LANCASTER RD
MOBILE AL
36608-1903
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-2663
  • Fax: 251-625-3198
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1871
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: