Provider Demographics
NPI:1700313210
Name:HUMPHREYS, ASHLEY GORDON (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GORDON
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 1:3070 COLLEGE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4688
Mailing Address - Country:US
Mailing Address - Phone:409-832-6200
Mailing Address - Fax:409-832-6216
Practice Address - Street 1:3070 COLLEGE ST STE 202
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4688
Practice Address - Country:US
Practice Address - Phone:409-832-6200
Practice Address - Fax:409-832-6216
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133919363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care