Provider Demographics
NPI:1235100785
Name:HUMPHRIES, SARAH LYNN (APN)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:LYNN
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 KANIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6417
Mailing Address - Country:US
Mailing Address - Phone:501-801-1200
Mailing Address - Fax:501-801-1207
Practice Address - Street 1:9101 KANIS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6417
Practice Address - Country:US
Practice Address - Phone:501-801-1200
Practice Address - Fax:501-801-1207
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01626363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W891Medicare ID - Type Unspecified