Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MS. EBONY BLACKMON HUMPHREY DNP ARNP PMHNP-BC
NPI 1669904108
Nurse Practitioner - Psychiatric/Mental Health in Issaquah, WA

Q: What is Ebony Blackmon Humphrey's NPI number?

The NPI number for Ebony Blackmon Humphrey is 1669904108. It was assigned to this individual provider in the NPPES registry on April 3, 2017.

Q: What is Ebony Blackmon Humphrey's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Active since April 03, 2017PECOS Enrolled

23205 SE BLACK NUGGET RD, APT J2, ISSAQUAH, WA 98029(206) 701-9363 Get Directions Write a Review

NPPES record last updated: August 10, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Aug 10, 2026, Sep 25, 2019 (2 updates tracked since 2019).

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About Ms. Ebony Blackmon Humphrey Dnp Arnp Pmhnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. EBONY BLACKMON HUMPHREY DNP ARNP PMHNP-BC (NPI 1669904108) is an individual psychiatric/mental health provider in Issaquah, Washington, licensed in Washington (AP60929540) and active in the NPI registry since April 2017. She is enrolled in Medicare PECOS and maintains a secondary practice location in Vancouver.

NPPES Registry Identity

NPI1669904108

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameMS. EBONY BLACKMON HUMPHREYCredential: DNP ARNP PMHNP-BC

Location Address23205 SE BLACK NUGGET RD, APT J2Issaquah, WA 98029-7326

Mailing Address400 Nw Gilman Blvd Unit 2862Issaquah, WA 98027-0258 · (206) 701-9363

Phone(206) 701-9363

Sole ProprietorYes

Enumeration DateApril 3, 2017

Last NPPES UpdateAugust 10, 20262 updates tracked since enumeration

NPPES CertifiedAugust 10, 2026

✔ NPI 1669904108 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in WA · AP60929540

Also ListedRegistered NurseTaxonomy 163W00000X · License RN60625891 (WA)

Also ListedRegistered Nurse · Case ManagementTaxonomy 163WC0400X · License RN60625891 (WA)

Also ListedRegistered Nurse · Psychiatric/Mental HealthTaxonomy 163WP0808X · License RN60625891 (WA)

23205 SE BLACK NUGGET RD, Issaquah, WA 98029

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Secondary Practice Location 1

Location 16100 NE Fourth Plain BlvdVancouver, WA 98661-6830 · Phone (360) 947-2550

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Ebony Blackmon Humphrey Dnp Arnp Pmhnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98029 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$97.43 typical visit price

range $63.67 – $189.37

Typical copayment $24.35 (range $15.91 – $47.34)

Most-billed visit code 99203

Established Patient

$111.00 typical visit price

range $21.12 – $155.00

Typical copayment $27.75 (range $5.28 – $38.75)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CARITAS CRITICAL CASE MANAGEMENT, LLC

Registered Nurse (Case Management)

23205 SE BLACK NUGGET RD, APT J2
ISSAQUAH, WA 98029

King County (206) 207-9363

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebony Blackmon Humphrey's NPI number?

The NPI number for Ebony Blackmon Humphrey is 1669904108. It was assigned to this individual provider in the NPPES registry on April 3, 2017.

Where is Ebony Blackmon Humphrey located?

Ebony Blackmon Humphrey practices at 23205 SE Black Nugget Rd Apt J2, Issaquah, WA 98029. The listed phone number is (206) 701-9363.

What is Ebony Blackmon Humphrey's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Ebony Blackmon Humphrey enrolled in Medicare?

Yes. Ebony Blackmon Humphrey is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ebony Blackmon Humphrey was last updated on August 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 41 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.