Provider Demographics
NPI:1578964318
Name:HUMPHRIES, SALLIE ANN (APRN, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:SALLIE
Middle Name:ANN
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:APRN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 DAVON LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-4041
Mailing Address - Country:US
Mailing Address - Phone:409-256-6556
Mailing Address - Fax:
Practice Address - Street 1:1434 DAVON LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-4041
Practice Address - Country:US
Practice Address - Phone:409-256-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX744544363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care