Provider Demographics
NPI:1003310087
Name:HAMPTON, RAYMOND FITZGERALD
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:FITZGERALD
Last Name:HAMPTON
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 1:701 MCMULLEN ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-5507
Mailing Address - Country:US
Mailing Address - Phone:662-322-4534
Mailing Address - Fax:
Practice Address - Street 1:7505 PINES RD STE 1200I
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129
Practice Address - Country:US
Practice Address - Phone:318-716-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator