Individual
MISS KAYLIE MARIE STAMCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1847 S LAKE DR, LEXINGTON, SC 29073-7759
(803) 356-8998
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4185
SC
363AM0700X
Medical Physician Assistant
50.006498RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-11220
NC PA LICENSE
NC
01
—
4185
SC PA LICENSE
SC
01
—
50.006498RX
PA LICENSE #
OH
Enumeration date
10/31/2018
Last updated
11/11/2024
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