Provider Demographics
NPI:1063448272
Name:STAMP, DEBORAH ANN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:STAMP
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 SW 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-6128
Mailing Address - Country:US
Mailing Address - Phone:806-352-9992
Mailing Address - Fax:806-352-9998
Practice Address - Street 1:4112 SW 50TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6128
Practice Address - Country:US
Practice Address - Phone:806-352-9992
Practice Address - Fax:806-352-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2016-05-20
Deactivation Date:2008-01-03
Deactivation Code:
Reactivation Date:2009-12-03
Provider Licenses
StateLicense IDTaxonomies
TX254595163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015057Medicaid
TX001015056Medicaid
TX175065501Medicaid
TX012105OtherSTATE LICENSURE
TX457839Medicare Oscar/Certification