Provider Demographics
NPI:1457526840
Name:HUMPHREYS, CATHERINE GRAVES (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:GRAVES
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6303
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4285
Practice Address - Country:US
Practice Address - Phone:864-455-2888
Practice Address - Fax:864-455-2885
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4690Medicaid
SCNP1268Medicaid
SCAA2979Medicare UPIN
SCAA29797951Medicare PIN
SC8688Medicare PIN
SCAA29793640Medicare PIN