Individual
MS. EBONY BLACKMON HUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP ARNP PMHNP-BC
Contact information
Practice address
23205 SE BLACK NUGGET RD, APT J2, ISSAQUAH, WA 98029-7326
(206) 701-9363
Mailing address
400 NW GILMAN BLVD UNIT 2862, ISSAQUAH, WA 98027-0258
(206) 701-9363
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60625891
WA
163WC0400X
Case Management Registered Nurse
RN60625891
WA
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN60625891
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60929540
WA
Other
Enumeration date
04/03/2017
Last updated
09/25/2019
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