MEDICARE: KALI HUMPHREY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP61604175	WA

General Provider Information

NPI Number	:	1851127054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALI HUMPHREY FNP-C

Provider Business Mailing Address
First Line	:	804 PATZER LN
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-9165
Country	:	US
Telephone Number	:	406-381-2752
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 W WELLESLEY AVE STE D
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-5009
Country	:	US
Telephone Number	:	509-598-7870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	01/15/2025

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