Healthcare Provider Details

I. General information

NPI: 1447460993
Provider Name (Legal Business Name): SALLIE M HAMPTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 CHILDERS STREET
LAMAR AR
72846
US

IV. Provider business mailing address

PO BOX 130
RATCLIFF AR
72951-0130
US

V. Phone/Fax

Practice location:
  • Phone: 479-885-3966
  • Fax: 479-885-3967
Mailing address:
  • Phone: 479-635-5300
  • Fax: 479-635-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA02976
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: