Healthcare Provider Details

I. General information

NPI: 1588749956
Provider Name (Legal Business Name): STACEY HUMPHREYS MSN, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD ST STE 201
SALISBURY MD
21804-6959
US

IV. Provider business mailing address

106 MILFORD ST STE 201
SALISBURY MD
21804-6959
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-1616
  • Fax: 410-543-8497
Mailing address:
  • Phone: 410-543-1616
  • Fax: 410-543-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024173915
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAC008959
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001267140
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: