Individual
CHARLES BRADY HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1002 TEXAS BLVD STE 400, TEXARKANA, TX 75501-5113
(903) 838-5500
(903) 838-7402
Mailing address
1002 TEXAS BLVD STE 400, TEXARKANA, TX 75501-5113
(903) 838-5500
(903) 838-7402
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02592
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200515720A
—
OK
05
—
297050101
—
TX
Enumeration date
11/13/2007
Last updated
07/28/2025
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