Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1104580109 |
---|---|
Provider Name | Derryin Ninaye Stampley |
First Address | Fayette, MS 39069-5051 |
Second Address | Fayette, MS 39069-5051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2021 |
Last Update Date | 26/10/2021 |