Healthcare Provider Details

I. General information

NPI: 1427848340
Provider Name (Legal Business Name): AMANDA HUMPHREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 E 32ND ST
TACOMA WA
98404-4922
US

IV. Provider business mailing address

2209 E 32ND ST
TACOMA WA
98404-4922
US

V. Phone/Fax

Practice location:
  • Phone: 253-593-0232
  • Fax: 253-441-2695
Mailing address:
  • Phone: 253-593-0232
  • Fax: 253-441-2695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0011634
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML61691960
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL.0011634
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: