Provider Demographics
NPI:1568985125
Name:HAMPTON, KIAYATTA D (LPN)
Entity Type:Individual
Prefix:
First Name:KIAYATTA
Middle Name:D
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 154TH PL APT 1R
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:IL
Mailing Address - Zip Code:60426-2682
Mailing Address - Country:US
Mailing Address - Phone:708-890-8749
Mailing Address - Fax:
Practice Address - Street 1:24735 S CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-3764
Practice Address - Country:US
Practice Address - Phone:708-769-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043107791164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse