Healthcare Provider Details

I. General information

NPI: 1184144073
Provider Name (Legal Business Name): JASMINE I. HUMPHREY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WARREN WAY
PROVIDENCE RI
02905-5000
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-0530
  • Fax: 401-444-0423
Mailing address:
  • Phone: 401-780-2511
  • Fax: 401-780-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2299344
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN03573
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2299344
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: