Provider Demographics
NPI:1356235006
Name:HAMPTON, STACEY L
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E MICHIGAN AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1850
Mailing Address - Country:US
Mailing Address - Phone:517-205-4605
Mailing Address - Fax:517-205-3832
Practice Address - Street 1:1100 E MICHIGAN AVE STE 307
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1850
Practice Address - Country:US
Practice Address - Phone:517-205-4605
Practice Address - Fax:517-205-3832
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker