Provider Demographics
NPI:1508399916
Name:HUMPHRIES, ROYLENA MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:ROYLENA
Middle Name:MICHELLE
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-0446
Mailing Address - Country:US
Mailing Address - Phone:504-704-8866
Mailing Address - Fax:
Practice Address - Street 1:524 S BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3448
Practice Address - Country:US
Practice Address - Phone:504-704-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator