MEDICARE: JALISA HAMPTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255682480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JALISA HAMPTON

Provider Business Mailing Address
First Line	:	2200 N TORREY PINES DR APT 2018
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-6506
Country	:	US
Telephone Number	:	702-619-1174
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N TORREY PINES DR APT 2018
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-6506
Country	:	US
Telephone Number	:	702-619-1174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	12/10/2021

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Directions to “ JALISA HAMPTON ” Practice Location

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