Provider Demographics
NPI:1013219278
Name:HAMPTON, KYLE NATHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:NATHAN
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:203 S ROLLIE AVE
Mailing Address - Street 2:BILLING DEPT - CREDENTIALIST
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1508
Mailing Address - Country:US
Mailing Address - Phone:303-286-4560
Mailing Address - Fax:303-286-4589
Practice Address - Street 1:1830 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2341
Practice Address - Country:US
Practice Address - Phone:970-416-6240
Practice Address - Fax:970-416-6241
Is Sole Proprietor?:No
Enumeration Date:2010-11-21
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11445207Q00000X
FLOS11654207Q00000X
CODR.0056040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006246300Medicaid
FL006246300Medicaid