Healthcare Provider Details

I. General information

NPI: 1417260928
Provider Name (Legal Business Name): ROSCOE H STAMPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 HIGHWAY 15 S
JACKSON KY
41339-8675
US

IV. Provider business mailing address

3830 HIGHWAY 15 S
JACKSON KY
41339-8675
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-5761
  • Fax: 606-436-5797
Mailing address:
  • Phone: 606-436-5761
  • Fax: 606-436-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: