Basic Information
| Provider Information | |||||||||
| NPI: | 1013219278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMPTON | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | NATHAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 S ROLLIE AVE | ||||||||
| Address2: | BILLING DEPT - CREDENTIALIST | ||||||||
| City: | FORT LUPTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806211508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032864560 | ||||||||
| FaxNumber: | 3032864589 | ||||||||
| Practice Location | |||||||||
| Address1: | 1830 LAPORTE AVE | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805212341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704166240 | ||||||||
| FaxNumber: | 9704166241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2010 | ||||||||
| LastUpdateDate: | 07/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A11445 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS11654 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DR.0056040 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 006246300 | 05 | FL | MEDICAID |