Provider Demographics
NPI:1356490460
Name:HAMPTON, JORDAN (PNP)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19A FOREST ST APT 23
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1534
Mailing Address - Country:US
Mailing Address - Phone:617-868-0210
Mailing Address - Fax:
Practice Address - Street 1:299 EVERETT AVE
Practice Address - Street 2:CHELSEA HIGH SCHOOL STUDENT HEALTH CENTER
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-1547
Practice Address - Country:US
Practice Address - Phone:617-889-8449
Practice Address - Fax:617-884-8187
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239348363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics