Provider Demographics
NPI:1487350104
Name:STAMPER, CICELY NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:CICELY
Middle Name:NICOLE
Last Name:STAMPER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 WARWICK CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2315
Mailing Address - Country:US
Mailing Address - Phone:859-382-2095
Mailing Address - Fax:
Practice Address - Street 1:3435 WARWICK CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-2315
Practice Address - Country:US
Practice Address - Phone:859-382-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2054306164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse