=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720340847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANET B HUMPHREYS NP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2012
-----------------------------------------------------
Last Update Date | 06/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1408 NEWCROSS RD
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-6052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-740-5399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 NEWCROSS RD
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-6052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-740-5399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MRS. JANET HUMPHREYS
-----------------------------------------------------
Credential | MSN, MPH, NP-C
-----------------------------------------------------
Telephone | 865-740-5399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APN0000008246
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------