Active NPI
Hailey Danielle Humphreys
- Nurse Practitioner
- Kennesaw, GA
National Provider Identifier
1730766841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 28142
- Practice address
- 2914 Cherokee St NW Ste 1a
Kennesaw, GA 30144-6526 - Phone
- (678) 846-2420
- NPI assigned
- Mar 25, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 28142 | TN | Primary |
Addresses
Primary practice location
2914 Cherokee St NW Ste 1a
Kennesaw, GA 30144-6526
Mailing address
121 County Road 321
Niota, TN 37826-3029
Phone (423) 507-3040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28142 | TN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616630400000",
"number": "1730766841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 COUNTY ROAD 321",
"city": "NIOTA",
"state": "TN",
"postal_code": "378263029",
"telephone_number": "423-507-3040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2914 CHEROKEE ST NW STE 1A",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301446526",
"telephone_number": "678-846-2420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMPHREYS",
"first_name": "HAILEY",
"middle_name": "DANIELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-25",
"last_updated": "2021-03-25",
"certification_date": "2021-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "TN",
"license": "28142",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.