Provider Demographics
NPI:1669476057
Name:HAMILTON, STEPHANIE L (PAC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:DOWDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:176 DAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9302
Mailing Address - Country:US
Mailing Address - Phone:304-647-4411
Mailing Address - Fax:304-793-2270
Practice Address - Street 1:102 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6761
Practice Address - Country:US
Practice Address - Phone:304-647-6559
Practice Address - Fax:304-793-2270
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV280363A00000X
WV01040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV562370581OtherSELECT NET (ACCORDIA)
47715Medicare UPIN
WV2029692Medicare PIN
WV2029691Medicare PIN
WV2029694Medicare PIN
WV2029693Medicare PIN