Provider Demographics
NPI:1437470978
Name:HUMPHREY, ALISON LEAH (MD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:LEAH
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4469
Mailing Address - Country:US
Mailing Address - Phone:817-614-9102
Mailing Address - Fax:
Practice Address - Street 1:626 BURNETT DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2941
Practice Address - Country:US
Practice Address - Phone:870-424-4200
Practice Address - Fax:870-424-4327
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6206207K00000X
MO2012003325208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics