Provider Demographics
NPI:1194024422
Name:HUMPHREY, DANIELLE ELISE (MD)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELISE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:ELISE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:STE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4910
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:4001 KRESGE WAY STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-895-1995
Practice Address - Fax:502-895-6479
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49230208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery