1093761132 NPI number — JESSICA D STEMPER P.A.-C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093761132 NPI number — JESSICA D STEMPER P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEMPER
Provider First Name:
JESSICA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093761132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 665
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALMA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68920-0665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-928-2103
Provider Business Mailing Address Fax Number:
308-928-2560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALMA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68920-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-928-2103
Provider Business Practice Location Address Fax Number:
308-928-2560
Provider Enumeration Date:
05/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  1039 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10025411700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025988200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025988300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200421770B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200421770C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025412200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00340971 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 200421770A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".