Provider Demographics
NPI:1831834290
Name:HUMPHREYS, CALLIE ANNE (DNAP)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:ANNE
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:DNAP
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:ANNE
Other - Last Name:TIERNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 ANGUS E PEYTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1600
Mailing Address - Country:US
Mailing Address - Phone:304-746-2088
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-4077
Practice Address - Fax:304-388-9852
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV92490163W00000X
WV120955367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse