Provider Demographics
NPI:1487004255
Name:HAMPTON, BRENDA JOYCE WILLIAMS
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JOYCE WILLIAMS
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JOYCE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 JOHN H CHAFEE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1034
Mailing Address - Country:US
Mailing Address - Phone:401-848-2160
Mailing Address - Fax:
Practice Address - Street 1:6 JOHN H CHAFEE BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1034
Practice Address - Country:US
Practice Address - Phone:401-848-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 376K00000X
RI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487004255Medicaid