Provider Demographics
NPI:1326540220
Name:STAMPER, TRISHA RENEE
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:RENEE
Last Name:STAMPER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TRISHA
Other - Middle Name:RENEE
Other - Last Name:ROBISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13331 N MACARTHUR BLVD APT 1015
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-8819
Mailing Address - Country:US
Mailing Address - Phone:405-697-8780
Mailing Address - Fax:
Practice Address - Street 1:13331 N MACARTHUR BLVD APT 1015
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-8819
Practice Address - Country:US
Practice Address - Phone:405-697-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator