Provider Demographics
NPI:1598183550
Name:HUMPHREYS, JESSICA (BS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:
Other - Last Name:HUMPHREYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:RM. 987
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-1137
Mailing Address - Country:US
Mailing Address - Phone:858-449-3032
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:RM. 987
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-1137
Practice Address - Country:US
Practice Address - Phone:858-449-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-06
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program