Holly Humphries
Individual provider Active NPI Registered Nurse · Pine Ridge, SD
NPI 1750838074 · NPPES record last updated Sep 2, 2016
Key facts
- NPI
- 1750838074
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 262299 (NC)
- Practice address
- East Highway 18
Pine Ridge, SD 57770 - Phone
- (605) 867-3006
- NPI assigned
- Sep 2, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 262299 | NC | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Ridge Indian Health Service Hospital | Past | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 262299 | NC | Yes |
Addresses
Primary practice location
East Highway 18
Pine Ridge, SD 57770
Mailing address
PO Box 1201
Pine Ridge, SD 57770-1201
Phone (605) 867-3006
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497786412 | Medicaid | SD |
Other providers in Pine Ridge, SD
- Nicole Joy Glines
- Paul Douglas Hall
- Johanna Christine Hewitt
- Virginia Horn
- Barbara Gale Hosei
- Indianhealthservices
- Desmon Inocencio
- Roberta M Jacobson
- Amber Nicole Janis
- Beverly Janis
All providers in Pine Ridge, SD · Registered Nurse in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.