Provider Demographics
NPI:1104580109
Name:STAMPLEY, DERRYIN NINAYE (CPS)
Entity type:Individual
Prefix:
First Name:DERRYIN
Middle Name:NINAYE
Last Name:STAMPLEY
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-5051
Mailing Address - Country:US
Mailing Address - Phone:601-809-6004
Mailing Address - Fax:
Practice Address - Street 1:28 SNYDER RD
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-5051
Practice Address - Country:US
Practice Address - Phone:601-809-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter