Healthcare Provider Details

I. General information

NPI: 1760231732
Provider Name (Legal Business Name): WINNITA HAMPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 ROSS ST
OAK GROVE LA
71263-9798
US

IV. Provider business mailing address

9528 ABERNATHY DR
MER ROUGE LA
71261-9706
US

V. Phone/Fax

Practice location:
  • Phone: 318-428-3237
  • Fax:
Mailing address:
  • Phone: 318-537-5064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202284
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: