Provider Demographics
NPI:1679288492
Name:HAMILTON, DAESHA MASHEA (APRN)
Entity Type:Individual
Prefix:
First Name:DAESHA
Middle Name:MASHEA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 MILLARD HWY
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-8162
Mailing Address - Country:US
Mailing Address - Phone:606-552-0400
Mailing Address - Fax:606-754-8007
Practice Address - Street 1:9613 MILLARD HWY
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-8162
Practice Address - Country:US
Practice Address - Phone:606-552-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily