Provider Demographics
NPI:1811410780
Name:HAMPTON, JORDAN ELIZABETH
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-2609
Mailing Address - Country:US
Mailing Address - Phone:270-737-5921
Mailing Address - Fax:270-982-0829
Practice Address - Street 1:108 NEW GLENDALE ROAD
Practice Address - Street 2:PO BOX 2609
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42702-2609
Practice Address - Country:US
Practice Address - Phone:270-737-5921
Practice Address - Fax:270-982-0829
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator