Provider Demographics
NPI:1568123107
Name:STAMPS, DAVID JORDAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JORDAN
Last Name:STAMPS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-3623
Mailing Address - Country:US
Mailing Address - Phone:318-294-8528
Mailing Address - Fax:
Practice Address - Street 1:2820 NAPOLEON AVE STE 650
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-8214
Practice Address - Country:US
Practice Address - Phone:504-899-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA223801367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered