Provider Demographics
NPI:1730534934
Name:MUMPHREY, CORTNEY RA'VON
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:RA'VON
Last Name:MUMPHREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140812
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-0812
Mailing Address - Country:US
Mailing Address - Phone:214-264-6011
Mailing Address - Fax:
Practice Address - Street 1:4931 JUNIUS ST
Practice Address - Street 2:UNIT #1
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-5309
Practice Address - Country:US
Practice Address - Phone:214-264-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide