Individual
REGINALD L HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-2020
(260) 266-2009
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000812A
IN
363LF0000X
Family Nurse Practitioner
APN0000012531
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200262080
—
IN
Enumeration date
08/09/2005
Last updated
10/20/2022
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