Provider Demographics
NPI:1184083818
Name:HAMPTON, NICOLETTE (NP-C)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 BENCH RD
Mailing Address - Street 2:STE B
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2013
Mailing Address - Country:US
Mailing Address - Phone:208-238-1000
Mailing Address - Fax:208-238-0009
Practice Address - Street 1:1951 BENCH RD
Practice Address - Street 2:STE B
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2013
Practice Address - Country:US
Practice Address - Phone:208-238-1000
Practice Address - Fax:208-238-0009
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1706A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0216480OtherAANP