Provider Demographics
NPI:1588365852
Name:HAMMOND, DUSTY SHANE
Entity type:Individual
Prefix:
First Name:DUSTY
Middle Name:SHANE
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N DOUTY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3951
Mailing Address - Country:US
Mailing Address - Phone:559-583-9300
Mailing Address - Fax:
Practice Address - Street 1:11517 15TH AVE
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9508
Practice Address - Country:US
Practice Address - Phone:559-380-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator