Provider Demographics
NPI:1366419459
Name:HAMPTON, JEANNINE (APRN)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 SILAS DEANE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2336
Mailing Address - Country:US
Mailing Address - Phone:860-257-4131
Mailing Address - Fax:
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2160
Practice Address - Country:US
Practice Address - Phone:860-886-2655
Practice Address - Fax:860-887-9003
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003178363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400003178CT01OtherANTHEM BLUE CROSS BS
CT002507654OtherUNITED
CT030178OtherCONNECTICARE
CT7168022OtherCIGNA
CTAA462740OtherHARVARD PILGRIM
CTP00437185OtherMEDICARE RAILROAD
CTP3599495OtherOXFORD
CT030178OtherCONNECTICARE
CT400003178CT01OtherANTHEM BLUE CROSS BS