Provider Demographics
NPI:1861469090
Name:HUMPHREY, JUNE ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JUNE ANN
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 NE 79TH CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1579
Mailing Address - Country:US
Mailing Address - Phone:816-810-3728
Mailing Address - Fax:
Practice Address - Street 1:1810 NE 79TH CT
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-1579
Practice Address - Country:US
Practice Address - Phone:816-810-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424008308Medicaid
MO424008308Medicaid
145B294AMedicare ID - Type Unspecified