Provider Demographics
NPI:1023555703
Name:HUMPHREY, JENNIFER SHERIDAN (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHERIDAN
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6890 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24148-3555
Mailing Address - Country:US
Mailing Address - Phone:276-956-1013
Mailing Address - Fax:276-956-1016
Practice Address - Street 1:6890 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:VA
Practice Address - Zip Code:24148-3555
Practice Address - Country:US
Practice Address - Phone:276-956-1013
Practice Address - Fax:276-956-1016
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174207363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology