Provider Demographics
NPI:1043920721
Name:HAMPTON, GRACE (NP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E BROAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6410
Mailing Address - Country:US
Mailing Address - Phone:682-518-1035
Mailing Address - Fax:682-518-1045
Practice Address - Street 1:2800 E BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6410
Practice Address - Country:US
Practice Address - Phone:682-518-1035
Practice Address - Fax:682-518-1045
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1013114163W00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse