Provider Demographics
NPI:1851717953
Name:HUMPHREYS, TASHA L (ARNP)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:L
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HAMPTON RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4807
Mailing Address - Country:US
Mailing Address - Phone:978-225-0835
Mailing Address - Fax:603-772-6761
Practice Address - Street 1:9 HAMPTON RD UNIT 2
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4807
Practice Address - Country:US
Practice Address - Phone:978-225-0835
Practice Address - Fax:603-772-6761
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH061014-21163W00000X
NH061014-23363L00000X
NH2021099543363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3095969Medicaid