Provider Demographics
NPI:1467429514
Name:VERSEN-RAMPEY, STACI L (ARNP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:L
Last Name:VERSEN-RAMPEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 RIVERCHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1777
Mailing Address - Country:US
Mailing Address - Phone:803-329-2636
Mailing Address - Fax:803-329-2184
Practice Address - Street 1:1436 RIVERCHASE BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1777
Practice Address - Country:US
Practice Address - Phone:803-329-2636
Practice Address - Fax:803-329-2184
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20081113363L00000X
FLARNP9216154363L00000X
SC3158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6903ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER#
FLP43106Medicare UPIN