Provider Demographics
NPI:1104008622
Name:DEBORAH A STAMP
Entity type:Organization
Organization Name:DEBORAH A STAMP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STAMP
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:806-352-9992
Mailing Address - Street 1:4112 SW 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-6128
Mailing Address - Country:US
Mailing Address - Phone:806-352-9992
Mailing Address - Fax:806-352-9998
Practice Address - Street 1:4112 SW 50TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6128
Practice Address - Country:US
Practice Address - Phone:806-352-9992
Practice Address - Fax:806-352-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009250251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015057Medicaid
TX012105OtherTEXAS
TX001015056Medicaid
TX001015056Medicaid