Individual
CRYSTAL JANE HUMPHRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1718 ALEXANDRIA DR, LEXINGTON, KY 40504-3144
(859) 276-1015
(859) 277-1015
Mailing address
112 CREEK ROCK CIR, NICHOLASVILLE, KY 40356-8037
(859) 948-3697
(502) 863-7542
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3011675
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001143675
ANTHEM PIN
—
05
—
300009625
—
IN
05
—
7100519400
—
KY
01
—
9919431
AETNA PIN
—
01
—
CS1814200203
CARESOURCE ID
—
01
—
PDZ000000064864
AETNA BETTER HEALTH
—
Enumeration date
08/25/2017
Last updated
05/13/2022
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