Provider Demographics
NPI:1528875192
Name:HUMPHREY, JUSTICE LYRIC (MSN, ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:JUSTICE
Middle Name:LYRIC
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 E 54TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2797
Mailing Address - Country:US
Mailing Address - Phone:563-355-9990
Mailing Address - Fax:
Practice Address - Street 1:1820 E 54TH ST STE B
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2797
Practice Address - Country:US
Practice Address - Phone:563-355-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA182502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily