Individual
BREANNA HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
750A WICKLOW PL, RIDGELAND, MS 39157-1236
(601) 540-7780
Mailing address
750A WICKLOW PL, RIDGELAND, MS 39157-1236
(601) 540-7780
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/26/2025
Last updated
07/26/2025
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