Provider Demographics
NPI:1477090306
Name:HAMPTON, PORTIA L (BSHA)
Entity Type:Individual
Prefix:MRS
First Name:PORTIA
Middle Name:L
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:BSHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12107 HERITAGE PARK RD APT 137
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9515
Mailing Address - Country:US
Mailing Address - Phone:501-672-0643
Mailing Address - Fax:
Practice Address - Street 1:12107 HERITAGE PARK RD APT 137
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9515
Practice Address - Country:US
Practice Address - Phone:501-672-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator