Provider Demographics
NPI:1730993189
Name:HUMPHREYS, BRANTLEY (RN-BSN)
Entity type:Individual
Prefix:
First Name:BRANTLEY
Middle Name:
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 BYRD CIR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-2347
Mailing Address - Country:US
Mailing Address - Phone:865-201-6627
Mailing Address - Fax:
Practice Address - Street 1:1373 BYRD CIR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2347
Practice Address - Country:US
Practice Address - Phone:865-201-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN233968163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health