Healthcare Provider Details

I. General information

NPI: 1386160737
Provider Name (Legal Business Name): NICOLE HUMPHREY PMHNP-BC APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 02/07/2026
Certification Date: 02/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST # 8168
DENVER CO
80203-1859
US

IV. Provider business mailing address

1500 N GRANT ST # 8168
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 719-414-7345
  • Fax: 303-879-8544
Mailing address:
  • Phone: 719-414-7345
  • Fax: 303-879-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0994555
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: