Provider Demographics
NPI:1932460045
Name:HUMPHRIES, EMERCHEL LYN (RN)
Entity Type:Individual
Prefix:MS
First Name:EMERCHEL
Middle Name:LYN
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620-F SUITE 6
Mailing Address - Street 2:W. LOOP 340
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-640-8868
Mailing Address - Fax:254-300-4891
Practice Address - Street 1:1620-F SUITE 6
Practice Address - Street 2:W. LOOP 340
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-640-8868
Practice Address - Fax:254-300-4891
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX782493163W00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174400000XOther Service ProvidersSpecialist