Humphrey, Charles Brady

Humphrey, Charles Brady is an individual health care provider with primary practice located at 2604 Saint Michael Dr Ste 425, Texarkana TX 75503-2379. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Humphrey, Charles Brady can be contacted via phone (903) 614-5600.

Contact Information

Primary practice address
2604 Saint Michael Dr Ste 425 Texarkana TX 75503-2379
Phone: (903) 614-5600
Fax: (903) 614-5630
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA02592 Texas

Profile Details

NPI number 1881874394
LBN Legal business name Humphrey, Charles Brady
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 13th, 2007
Last updated May 7th, 2021 - about 3 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 1881874394 NPPES
Oklahoma MEDICAID 200515720A
Oklahoma MEDICAID 297050101

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