Healthcare Provider Details

I. General information

NPI: 1194649962
Provider Name (Legal Business Name): SCOTTIE JANE STAMPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900B PARK RD
CHARLOTTE NC
28209-2133
US

IV. Provider business mailing address

616 COURTNEY LN
MATTHEWS NC
28105-1581
US

V. Phone/Fax

Practice location:
  • Phone: 704-527-7907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA23347
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: