Healthcare Provider Details

I. General information

NPI: 1649095571
Provider Name (Legal Business Name): KATHERINE G. HUMPHREY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 BENFIELD RD STE 100
SEVERNA PARK MD
21146-2527
US

IV. Provider business mailing address

1405 POINT ST APT 1706
BALTIMORE MD
21231-3695
US

V. Phone/Fax

Practice location:
  • Phone: 410-929-2166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE G HUMPHREY
Title or Position: FOUNDER, NURSE PRACTITIONER
Credential: DNP
Phone: 410-929-2166