Provider Demographics
NPI:1073251716
Name:KELLEY-HUMPHREY, NAKIA DEONTRANISE (STA)
Entity Type:Individual
Prefix:MRS
First Name:NAKIA
Middle Name:DEONTRANISE
Last Name:KELLEY-HUMPHREY
Suffix:
Gender:F
Credentials:STA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 CHUPAROSA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-7246
Mailing Address - Country:US
Mailing Address - Phone:256-919-7464
Mailing Address - Fax:
Practice Address - Street 1:9425 CHUPAROSA DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-7246
Practice Address - Country:US
Practice Address - Phone:256-919-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX424572355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant