Provider Demographics
NPI:1649225996
Name:HAMPTON, SONJA B (RN, BC, FNP)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:B
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:RN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 HWY OO
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640
Mailing Address - Country:US
Mailing Address - Phone:573-756-6451
Mailing Address - Fax:573-701-7117
Practice Address - Street 1:1101 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1921
Practice Address - Country:US
Practice Address - Phone:573-701-7215
Practice Address - Fax:573-701-7117
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO064168 MO363L00000X
MO064168363LF0000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1649225996Medicaid
MO132100004Medicare PIN
MOS72446Medicare UPIN
MO132100004Medicare PIN