Provider Demographics
NPI:1891088084
Name:STAMPER, MATTHEW JAMISON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAMISON
Last Name:STAMPER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 S 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3906
Mailing Address - Country:US
Mailing Address - Phone:785-827-2238
Mailing Address - Fax:785-827-1684
Practice Address - Street 1:200 S 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3906
Practice Address - Country:US
Practice Address - Phone:785-827-2238
Practice Address - Fax:785-827-1684
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC087181367500000X
SC20891367500000X
KS557844367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered