Provider Demographics
NPI:1093261497
Name:HAMPTON, SHAUN (NP)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 E IRONWOOD SQUARE DR STE 125
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4582
Mailing Address - Country:US
Mailing Address - Phone:623-328-9704
Mailing Address - Fax:623-888-8570
Practice Address - Street 1:9500 E IRONWOOD SQUARE DR STE 125
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4582
Practice Address - Country:US
Practice Address - Phone:480-626-2552
Practice Address - Fax:480-626-2551
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ215758OtherMEDICARE PTAN
AZ214446Medicaid