Individual
ANDREA PEARL HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3213 N 8TH PL, BROKEN ARROW, OK 74012-8221
(918) 894-3700
Mailing address
3213 N 8TH PL, BROKEN ARROW, OK 74012-8221
(918) 894-3700
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1231
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200017780
—
OK
Enumeration date
06/20/2006
Last updated
08/29/2014
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