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: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16244 BENNETT RD
CULPEPER VA
22701-4630
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 540-825-5381
  • Fax: 540-829-0945
Mailing address:
  • Phone: 342-951-1000
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: