Provider Demographics
NPI:1720087539
Name:STAMPER, JASON JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JOHN
Last Name:STAMPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19485 OLD JETTON RD STE 210
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6592
Practice Address - Country:US
Practice Address - Phone:704-316-1830
Practice Address - Fax:704-316-1835
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103433363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00021556OtherRAILROAD MEDICARE
P00021556OtherRAILROAD MEDICARE
P65725Medicare UPIN
SCAA50696191Medicare PIN