Provider Demographics
NPI:1275654691
Name:HAMPTON, MELANIE GRACE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:GRACE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:GRACE
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:7691 S VIVALDI CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-9631
Mailing Address - Country:US
Mailing Address - Phone:520-777-4301
Mailing Address - Fax:520-777-4301
Practice Address - Street 1:5981 E GRANT RD
Practice Address - Street 2:SUITE 115
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2363
Practice Address - Country:US
Practice Address - Phone:520-886-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR038363363LA2200X
AZAP3096363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD867ZOtherINDIVIDUAL
MD699374500Medicaid
MD595666Medicare UPIN