Provider Demographics
NPI:1215094024
Name:HUMPHREY, LINDA C (ARNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SE WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3058
Mailing Address - Country:US
Mailing Address - Phone:360-748-7400
Mailing Address - Fax:360-740-8309
Practice Address - Street 1:500 SE WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3058
Practice Address - Country:US
Practice Address - Phone:360-748-7400
Practice Address - Fax:360-740-8309
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9651373Medicaid
WAAP30007562OtherPROFESSIONAL LICENSE
MH1523198OtherDEA
WA9651373Medicaid
MH1523198OtherDEA