MEDICARE: MS. SHEILA HUMPHREY NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	P001592	AR

General Provider Information

NPI Number	:	1992126189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHEILA HUMPHREY NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1120 MACK RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-5790
Country	:	US
Telephone Number	:	501-888-3904
Fax Number	:	501-888-3904

Provider Business Practice Location Address
First Line	:	1120 MACK RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-5790
Country	:	US
Telephone Number	:	501-888-3904
Fax Number	:	501-888-3904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2013
Last Update Date	:	12/14/2013

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