MS. EBONY BLACKMON HUMPHREY (NPI# 1669904108) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669904108 |
| Entity Type | Individual |
| Full Name | MS. EBONY BLACKMON HUMPHREY |
| Credential | DNP ARNP PMHNP-BC |
| Practice Address |
23205 Se Black Nugget Rd Apt J2 Issaquah WA 98029-7326 |
| Mailing Address |
400 Nw Gilman Blvd Unit 2862 Issaquah WA 98027-0258 |
| Practice Telephone | 2067019363 |
| Mailing Telephone | 2067019363 |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2019-09-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN60625891 | WA | Nursing Service Providers |
| N | 163WC0400X |
Registered Nurse Specialization: Case Management |
RN60625891 | WA | Nursing Service Providers |
| N | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
RN60625891 | WA | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP60929540 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
23205 SE BLACK NUGGET RD APT J2 |
| City | ISSAQUAH |
| State | WA |
| Zip Code | 98029-7326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659806032 | Caritas Critical Case Management, LLC | Registered Nurse | 23205 Se Black Nugget Rd, Apt J2, Issaquah, WA 98029-7326 | 2017-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134730161 | Katelyn Creech | Counselor | 1505 16th Lane Ne, Apt 404 Building O, Issaquah, WA 98029 | 2020-08-13 |
| 1326695438 | M Shoaib Haider Siddiqui | Dentist | Issaquah Modern Dentistry, 1416 Highlands Drie Ne, Suite 120, Issaquah, WA 98029 | 2019-08-22 |
| 1053885061 | Rose Osborne | Registered Nurse | 4580 Klahanie Dr Se #181, Sammamish, WA 98029 | 2019-01-14 |
| 1598260960 | Caryn Crosbie | Behavior Technician | 22526 Se 64th Place, Building D Suite 210, Issaquah, WA 98029 | 2018-03-28 |
| 1194110908 | May Y. Mar | Family Medicine | 5708 E. Lake Sammamish Pkwy Se, Issaquah, WA 98029 | 2015-03-30 |
| 1659765816 | Eastside Social Skills Therapy LLC | Preferred Provider Organization | 5436 232nd Ave Se, Issaquah, WA 98029 | 2015-03-26 |
| 1649513946 | Linda Scoppettone Knodel | Registered Nurse | 5303 231 Ave. Se, Issaquah, WA 98029 | 2013-04-04 |
| 1720323116 | Morley Slutsky | Preventive Medicine | 4580 Klahanie Dr. S.e.,#125, Issaquah, WA 98029 | 2012-12-11 |
| 1619248820 | Silas Dickenson Dudley | Dentist | 2520 Ne Park Dr, Suite C, Issaquah, WA 98029 | 2012-01-19 |
| 1659641678 | Cynthia J Creel | Technician/Technologist | 4580 Klahanie Dr. Se, #332, Issaquah, WA 98029 | 2012-01-06 |
| Find all providers in zip 98029 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174140677 | Rachael Davison | Nurse Practitioner | 22525 Se 64th Pl Ste 228, Issaquah, WA 98027-5383 | 2020-06-30 |
| 1568941706 | Jeanne Nicholson Wadsworth | Nurse Practitioner | 310 3rd Ave Ne Ste 105, Issaquah, WA 98027-3345 | 2018-08-08 |
| 1649727249 | Brett Lee Wadsworth | Nurse Practitioner | 6520 226th Pl Se Ste 203, Issaquah, WA 98027-8969 | 2016-09-01 |
| 1972683571 | Audrey Jean Church | Nurse Practitioner | 2344 Ne Marion Ln, Issaquah, WA 98029-3661 | 2006-10-17 |
| 1225566417 | Wadsworth Psychiatric Services Pllc | Nurse Practitioner | 6520 226th Pl Se Ste 203, Issaquah, WA 98027-8969 | 2017-06-01 |
| 1467624049 | Saskia E Vonmichalofski | Nurse Practitioner | 5837 221st Pl Se, Issaquah, WA 98027-8917 | 2008-03-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720139 | Youwen Hu | Nurse Practitioner | 10824 Se 170th St Unit A304, Renton, WA 98055-5950 | 2020-11-05 |
| 1831799048 | Sarah Louise Weerheim | Nurse Practitioner | 2727 Hollycroft St Ste 110v, Gig Harbor, WA 98335-1371 | 2020-10-27 |
| 1619576774 | Bethany Heath Arnp-pmhnp Pllc | Nurse Practitioner | 1224 West Riverside, Apt 408, Spokane, WA 99201 | 2020-10-20 |
| 1437761988 | Hollye Hahn | Nurse Practitioner | 1012 Nw Longview Dr, Oak Harbor, WA 98277-8947 | 2020-08-17 |
| 1386254290 | Candie M. Wellwood | Nurse Practitioner | 9908 S Sherman Rd, Spokane, WA 99224-9811 | 2020-08-05 |
| 1104434679 | Progressive Psychiatric Consultant | Nurse Practitioner | 170 S Lincoln St # 150, Spokane, WA 99201-4443 | 2020-07-21 |
| 1235747213 | Peaceful Coexistence, LLC | Nurse Practitioner | 4730 University Way Ne Ste 104, Seattle, WA 98105-4424 | 2020-07-16 |
| 1134747066 | New Dawn Psychotherapy Pllc | Nurse Practitioner | 2223 Benson Rd S Apt D102, Renton, WA 98055-8837 | 2020-07-07 |
| 1376160861 | Clarity Behavioral Health | Nurse Practitioner | 7704 193rd Pl Sw, Edmonds, WA 98026-6234 | 2020-06-30 |
| 1326668856 | Healing Heart Therapeutic Services | Nurse Practitioner | 1915 2nd Ave Apt 2212, Seattle, WA 98101-3165 | 2020-04-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.