Provider Demographics
NPI:1518494293
Name:HUMPHRYS, JOHN F (PNP, PMHNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:F
Last Name:HUMPHRYS
Suffix:
Gender:M
Credentials:PNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3519
Mailing Address - Country:US
Mailing Address - Phone:781-752-5158
Mailing Address - Fax:
Practice Address - Street 1:147 COURT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8724
Practice Address - Country:US
Practice Address - Phone:781-752-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277690163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse