Basic Information
Provider Information
NPI: 1548215239
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAMPTON
FirstName: MARGIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PSYCH ASSOCIATE
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 259 PARKERS MILL RD
Address2:  
City: SOMERSET
State: KY
PostalCode: 425013152
CountryCode: US
TelephoneNumber: 6066794782
FaxNumber: 6066785296
Practice Location
Address1: 113 HARDIN LN
Address2:  
City: SOMERSET
State: KY
PostalCode: 425033814
CountryCode: US
TelephoneNumber: 6066796251
FaxNumber: 6066794156
Other Information
ProviderEnumerationDate: 05/23/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC2200X247KYY Behavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent

No ID Information.


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