Humphrey, Reginald L

Humphrey, Reginald L is an individual health care provider with primary practice located at 11109 Parkview Plaza Dr , Fort Wayne IN 46845-1701. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Humphrey, Reginald L can be contacted via phone (260) 266-2020.

Contact Information

Primary practice address
11109 Parkview Plaza Dr Fort Wayne IN 46845-1701
Phone: (260) 266-2020
Fax: (260) 266-2009
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APN0000012531 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 71000812A Indiana

Profile Details

NPI number 1619978178
LBN Legal business name Humphrey, Reginald L
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2005
Last updated Oct 20th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619978178 NPPES
Indiana MEDICAID 200262080

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