Healthcare Provider Details

I. General information

NPI: 1477361343
Provider Name (Legal Business Name): MAKAYLA KENIKE HAMPTON-BARNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 CHIPPEWA DR
BELLEVILLE IL
62221-3516
US

IV. Provider business mailing address

3461 CHIPPEWA DR
BELLEVILLE IL
62221-3516
US

V. Phone/Fax

Practice location:
  • Phone: 618-567-0139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2017023309
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: