Provider Demographics
NPI:1639504871
Name:HAMMACK, RICHARD WAYNE (NP-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WAYNE
Last Name:HAMMACK
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 SW ABBEY ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4820
Mailing Address - Country:US
Mailing Address - Phone:541-574-1818
Mailing Address - Fax:541-574-1831
Practice Address - Street 1:930 SW ABBEY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4820
Practice Address - Country:US
Practice Address - Phone:541-574-1818
Practice Address - Fax:541-574-1831
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78103363LF0000X
COAPN.0990879-NP363LF0000X
OR201603408NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily