Provider Demographics
NPI:1164433587
Name:HAMILTON, WILLIE (FNP)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 ROSS CARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:DUFFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24244-5117
Mailing Address - Country:US
Mailing Address - Phone:276-690-7161
Mailing Address - Fax:276-690-7246
Practice Address - Street 1:198 ROSS CARTER BLVD
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244-5117
Practice Address - Country:US
Practice Address - Phone:276-690-7161
Practice Address - Fax:276-690-7246
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN00115147363L00000X
TN7613363LF0000X
VA0024170002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007794851Medicaid
TNP88422Medicare UPIN
VA007794851Medicaid