Provider Demographics
NPI:1225726904
Name:HUMPHRIES, WILLIAM JUDSON (MSN MBA APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JUDSON
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:MSN MBA APRN FNP-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-0837
Mailing Address - Country:US
Mailing Address - Phone:936-241-5060
Mailing Address - Fax:936-241-5065
Practice Address - Street 1:1613 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-2207
Practice Address - Country:US
Practice Address - Phone:936-241-5060
Practice Address - Fax:936-241-5065
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX729889163W00000X
TX1116917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse