Provider Demographics
NPI:1457787327
Name:HAMPTON, EBONY M (RN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:M
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 MEREDITH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1423
Mailing Address - Country:US
Mailing Address - Phone:614-772-2804
Mailing Address - Fax:
Practice Address - Street 1:2422 MEREDITH DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1423
Practice Address - Country:US
Practice Address - Phone:614-772-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.154301-M-IV164W00000X
OHRN.428220163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0097105Medicaid