Healthcare Provider Details

I. General information

NPI: 1952380271
Provider Name (Legal Business Name): JANET B HUMPHREYS MSN, MPH, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 NEWCROSS RD
KNOXVILLE TN
37922-6052
US

IV. Provider business mailing address

PO BOX 5777 SUITE 230
MARYVILLE TN
37802-5777
US

V. Phone/Fax

Practice location:
  • Phone: 865-691-4794
  • Fax:
Mailing address:
  • Phone: 865-246-2104
  • Fax: 865-246-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN0000008246
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00001331411
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: