Basic Information
| Provider Information | |||||||||
| NPI: | 1841666237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMPTON | ||||||||
| FirstName: | TRACIE | ||||||||
| MiddleName: | BARKSDALE | ||||||||
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| Credential: | PMHNP, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 324 T B STANLEY HWY | ||||||||
| Address2: | |||||||||
| City: | BASSETT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240556108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766291076 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 CLEVELAND AVE STE D | ||||||||
| Address2: | |||||||||
| City: | MARTINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241123700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7633633262 | ||||||||
| FaxNumber: | 2763363338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2015 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 0024172867 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.