Provider Demographics
NPI:1013302660
Name:HUMPHREY, KRIS-ANN SHANIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRIS-ANN
Middle Name:SHANIQUE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRIS-ANN
Other - Middle Name:SHANIQUE
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 CONCOURSE PKWY S
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6114
Mailing Address - Country:US
Mailing Address - Phone:407-767-6411
Mailing Address - Fax:407-767-8160
Practice Address - Street 1:790 CONCOURSE PKWY S STE 200
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6114
Practice Address - Country:US
Practice Address - Phone:407-767-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL146759207W00000X, 207WX0009X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty