=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255908802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JASON N STAMPER DO PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2021
-----------------------------------------------------
Last Update Date | 03/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 551 HAMBLEY BLVD STE 2
-----------------------------------------------------
City | PIKEVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41501-3798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-432-2335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1559
-----------------------------------------------------
City | PIKEVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41502-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-805-6232
-----------------------------------------------------
Fax | 606-253-3040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | JASON NOAH STAMPER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 404-805-6232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------