1366790420 NPI number — MRS. SARAH STAMPLEY PEPPER M.S.

Table of content: MRS. SARAH STAMPLEY PEPPER M.S. (NPI 1366790420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366790420 NPI number — MRS. SARAH STAMPLEY PEPPER M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEPPER
Provider First Name:
SARAH
Provider Middle Name:
STAMPLEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
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:
1366790420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 JEFFERSON BLVD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-487-5395
Provider Business Mailing Address Fax Number:
318-487-5463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 JEFFERSON BLVD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-487-5395
Provider Business Practice Location Address Fax Number:
318-487-5463
Provider Enumeration Date:
08/21/2012

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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