Provider Demographics
NPI:1407829195
Name:HUMPHREY, MARGARET ELLEN (ARNP, CNS, CS)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:ARNP, CNS, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 BURKE ST
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-2414
Mailing Address - Country:US
Mailing Address - Phone:620-223-0388
Mailing Address - Fax:620-223-3474
Practice Address - Street 1:1024 BURKE ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2414
Practice Address - Country:US
Practice Address - Phone:620-223-0388
Practice Address - Fax:620-223-3474
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4259875602Medicaid
KS4259875602Medicaid