MEDICARE: STASHA NICOLE HAMPTON APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	29733	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN000029733	TN

General Provider Information

NPI Number	:	1407522980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STASHA NICOLE HAMPTON APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	5906 CHARLOTTE PIKE STE D
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3181
Country	:	US
Telephone Number	:	629-888-4161
Fax Number	:	629-888-4154

Provider Business Practice Location Address
First Line	:	5906 CHARLOTTE PIKE STE D
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3181
Country	:	US
Telephone Number	:	629-888-4161
Fax Number	:	629-888-4154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	09/07/2023

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