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General NPI Number Information
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NPI Number | 1194642751
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Entity Type | Individual
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Provider Name | JASON HUMPHRIES
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Gender | Male
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Dates
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Enumeration Date | 07/02/2026
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Last Update Date | 07/02/2026
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Provider Practice Location Address
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Address Line | 2165 REYNOLDS RIDGE LN APT 307
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City | FORT MILL
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State | SC
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Zip | 29708-2103
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Country | US
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Telephone | 803-804-2622
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Fax |
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Provider Business Mailing Address
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Address Line | 2165 REYNOLDS RIDGE LN APT 307
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City | FORT MILL
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State | SC
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Zip | 29708-2103
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Country | US
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Telephone | 803-804-2622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | SC007262
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 146E00000X
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Taxonomy Name | Community Paramedic
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License Number | 991
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License Number State | SC
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