Provider Demographics
NPI:1053571596
Name:HAMPTON, MAVIS O (RN, FNP)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:O
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8128
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75404-8128
Mailing Address - Country:US
Mailing Address - Phone:903-454-8111
Mailing Address - Fax:903-454-1680
Practice Address - Street 1:1607 E QUINLAN PKWY
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474
Practice Address - Country:US
Practice Address - Phone:903-356-2144
Practice Address - Fax:903-356-3025
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113729363L00000X
TX616828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX313835YRYGMedicare PIN
TX8L22712Medicare PIN
TX208859303Medicaid
TX208859302Medicaid
TX8L22713Medicare PIN