Healthcare Provider Details

I. General information

NPI: 1750089033
Provider Name (Legal Business Name): HUMPHREY HEALTH SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 SE I ST STE 7
BENTONVILLE AR
72712-0078
US

IV. Provider business mailing address

2713 SE I ST STE 7
BENTONVILLE AR
72712-0078
US

V. Phone/Fax

Practice location:
  • Phone: 479-391-8186
  • Fax: 479-336-6459
Mailing address:
  • Phone: 479-391-8186
  • Fax: 479-336-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HEATHER HUMPHREY
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 479-391-8186