Humphrey, Ken Allen

Humphrey, Ken Allen is an individual health care provider with primary practice located at 15 Cranton Way #112 Suite #112, Lake Wylie SC 29710. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Humphrey, Ken Allen can be contacted via phone (803) 831-7916.

Contact Information

Primary practice address
15 Cranton Way #112 Suite #112 Lake Wylie SC 29710
Phone: (803) 831-7916
Fax: (803) 831-7916
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD2004-0215 New Mexico
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X G40969 California
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD-23075 South Carolina

Profile Details

NPI number 1043268352
LBN Legal business name Humphrey, Ken Allen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 5th, 2006
Last updated Mar 4th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043268352 NPPES
California MEDICAID 00G409690
California MEDICAID 230752
California MEDICAID 93757018

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