Provider Demographics
NPI:1669066080
Name:HUMPHREY, LATONYA Y (LPN)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:Y
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 N PRUETT ST APT 65
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-4568
Mailing Address - Country:US
Mailing Address - Phone:337-377-9466
Mailing Address - Fax:
Practice Address - Street 1:907 N PRUETT ST APT 65
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-4568
Practice Address - Country:US
Practice Address - Phone:337-377-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA272557164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty