Provider Demographics
NPI:1417533050
Name:HUMPHREY, KRISTEN NELSON (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NELSON
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 140TH AVE NE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6943
Mailing Address - Country:US
Mailing Address - Phone:425-483-5437
Mailing Address - Fax:425-488-4919
Practice Address - Street 1:17000 140TH AVE NE UNIT 102
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6943
Practice Address - Country:US
Practice Address - Phone:425-483-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program