Healthcare Provider Details

I. General information

NPI: 1780227496
Provider Name (Legal Business Name): CASSIE LAINE HAMPTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N WINNSBORO ST
QUITMAN TX
75783-2144
US

IV. Provider business mailing address

PO BOX 130549
TYLER TX
75713-0549
US

V. Phone/Fax

Practice location:
  • Phone: 903-763-6220
  • Fax: 903-763-6222
Mailing address:
  • Phone: 903-579-3931
  • Fax: 903-509-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP143776
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: