Provider Demographics
NPI:1982695482
Name:HUMKEY, MARY J (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:HUMKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:FRENCHBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40322-8123
Mailing Address - Country:US
Mailing Address - Phone:606-768-2191
Mailing Address - Fax:606-768-6130
Practice Address - Street 1:732 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:FRENCHBURG
Practice Address - State:KY
Practice Address - Zip Code:40322-8123
Practice Address - Country:US
Practice Address - Phone:606-768-2191
Practice Address - Fax:606-768-6130
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64238637Medicaid
KY080041750OtherRAILROAD MEDICARE
KY080020949OtherRAILROAD MEDICARE
KY080025855OtherRAILROAD MEDICARE
KY080025861OtherRAILROAD MEDICARE
KY0074291Medicare PIN
KY080025855OtherRAILROAD MEDICARE
KYC67754Medicare UPIN
KY0216379Medicare PIN
KY080025861OtherRAILROAD MEDICARE
KY1063392Medicare PIN