Provider Demographics
NPI:1063951077
Name:HAMPTON, DENA DOURISSEAU (MS, RDN, LDN, CDE)
Entity type:Individual
Prefix:MRS
First Name:DENA
Middle Name:DOURISSEAU
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:MS, RDN, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4064 PINE HILL CV S
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8129
Mailing Address - Country:US
Mailing Address - Phone:402-707-0250
Mailing Address - Fax:
Practice Address - Street 1:3461 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3801
Practice Address - Country:US
Practice Address - Phone:901-261-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1092560133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered