Provider Demographics
NPI:1366770455
Name:HAMPTON, TRACY LYNN (RN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3031
Mailing Address - Country:US
Mailing Address - Phone:937-274-0996
Mailing Address - Fax:
Practice Address - Street 1:2218 RUGBY RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3031
Practice Address - Country:US
Practice Address - Phone:937-274-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131982-IV164W00000X
OH377818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse