Healthcare Provider Details

I. General information

NPI: 1053725135
Provider Name (Legal Business Name): TAMMI PARKER HAMPTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CLEVELAND AVE STE 14
MARTINSVILLE VA
24112-2937
US

IV. Provider business mailing address

15 CLEVELAND AVE STE 15
MARTINSVILLE VA
24112-2937
US

V. Phone/Fax

Practice location:
  • Phone: 434-429-3871
  • Fax:
Mailing address:
  • Phone: 434-429-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0024188755
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: