Individual
MRS. KALLIE BLYTHE HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3300 NW EXPRESSWAY, OKLAHOMA CITY, OK 73112-4999
(405) 949-3011
Mailing address
PO BOX 269032, OKLAHOMA CITY, OK 73126-9032
(405) 951-2545
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2188
OK
363AM0700X
Medical Physician Assistant
APA2188
OK
Other
Enumeration date
12/19/2012
Last updated
06/08/2022
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