Provider Demographics
NPI:1023638038
Name:HUMPHREY, LAURA ANN
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S GRAND BLVD APT 408
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1573
Mailing Address - Country:US
Mailing Address - Phone:562-896-5897
Mailing Address - Fax:
Practice Address - Street 1:ALLIED HEALTH BUILDING 3437 CAROLINE STREET, ROOM 3015
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-977-8639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant