Active NPI
Clemmie Kay Humphreys-Roseberry, SLP
- Speech-Language Pathologist
- Fairfield Bay, AR
National Provider Identifier
1952542276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 320
- Practice address
- 265 Dave Creek Pky
Fairfield Bay, AR 72088-9519 - Phone
- (501) 884-3210
- NPI assigned
- Mar 17, 2009
- Last updated
- Mar 30, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 320 | AR | Primary |
Addresses
Primary practice location
265 Dave Creek Pky
Fairfield Bay, AR 72088-9519
Mailing address
124 Davis Dr
Edgemont, AR 72044-9519
Phone (870) 948-2441
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 320 | AR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238371200000",
"number": "1952542276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 DAVIS DR",
"city": "EDGEMONT",
"state": "AR",
"postal_code": "720449519",
"telephone_number": "870-948-2441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "265 DAVE CREEK PKY",
"city": "FAIRFIELD BAY",
"state": "AR",
"postal_code": "720889519",
"telephone_number": "501-884-3210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMPHREYS-ROSEBERRY",
"first_name": "CLEMMIE",
"middle_name": "KAY",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-03-17",
"last_updated": "2009-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield Bay, AR
- S M Hassan Bashiri, DMD MS
- Bennett Health Services, Inc. (Fairfield Bay Pharmacy)
- Bennett Health Services, Inc.
- City of Fairfield Bay
- Healthy Changes Whole Health & Mobility, LLC
- Indian Rock Al LLC
- Indian Rock Healthcare LLC (The Springs of Fairfield Bay)
- Indian Rock Healthcare LLC (The Springs of Fairfield Bay)
- Indian Rock Village, LLC
- Jodi Marie Keller
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.