Provider Demographics
NPI:1104168921
Name:HAMPTON, CARLY ELISE (BSN,RN,MSN, CNM)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ELISE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:BSN,RN,MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CENTRE ST PH 120
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4559
Mailing Address - Country:US
Mailing Address - Phone:888-731-8994
Mailing Address - Fax:
Practice Address - Street 1:139 CENTRE ST PH 120
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4559
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN575828163W00000X
NY828877163W00000X
PAMW010303367A00000X
NY421547363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife