CHARLES BRADY HUMPHREY (NPI# 1881874394) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881874394 |
| Entity Type | Individual |
| Full Name | CHARLES BRADY HUMPHREY |
| Credential | PA |
| Practice Address |
2604 Saint Michael Dr Ste 425 Texarkana TX 75503-2379 |
| Mailing Address |
919 Hidden Rdg Irving TX 75038-3813 |
| Practice Telephone | 9036145600 |
| Practice Fax Number | 9036145630 |
| Mailing Telephone | 4692822711 |
| Mailing Fax Number | 4692822609 |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2016-09-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA02592 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 297050101 | 05 | |
| OK | 200515720A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073176798 | Charles B Humphrey | Behavior Technician | 27777 Inkster Rd Ste 100, Farmington Hills, MI 48334-5326 | 2019-04-18 |
| 1346539293 | Charles Robert Humphrey | Pharmacist | 13955 State Rd, North Royalton, OH 44133-3965 | 2011-03-31 |
| 1447355508 | Charles Rogers Humphrey | Surgery | 1415 Ross Ave, El Centro, CA 92243-4306 | 2006-09-13 |
| 1164402640 | Charles C Humphrey | Radiology | 300 Main St, Lewiston, ME 04240-7007 | 2006-01-19 |
| Street Address |
2604 SAINT MICHAEL DR STE 425 |
| City | TEXARKANA |
| State | TX |
| Zip Code | 75503-2379 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407841984 | Texarkana Cardiovascular & Thoracic Surgical Associates Pa | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2604 Saint Michael Dr, Suite 425, Texarkana, TX 75503-2379 | 2005-09-12 |
| 1265988208 | Kellie Lyn Flaherty | Physician Assistant | 2604 Saint Michael Dr, Suite 340, Texarkana, TX 75503-2379 | 2016-08-30 |
| 1932571577 | Kimberly Scott | Nurse Practitioner | 2604 Saint Michael Dr, Ste 239, Texarkana, TX 75503-2379 | 2015-10-22 |
| 1790162238 | Christus Health Ark-la-tex | Internal Medicine | 2604 Saint Michael Dr, Ste 238, Texarkana, TX 75503-2379 | 2015-05-05 |
| 1740603521 | Christus Health Ark-la-tex | General Practice | 2604 Saint Michael Dr, 1st Floor, Texarkana, TX 75503-2379 | 2014-01-29 |
| 1780018143 | Yolanda Bone | Nurse Practitioner | 2604 Saint Michael Dr, Suite 238, Texarkana, TX 75503-2379 | 2013-08-21 |
| 1295047918 | Olubunmi A Ojelade | Family Medicine | 2604 Saint Michael Dr, Ste 340, Texarkana, TX 75503-2379 | 2010-07-10 |
| 1235369307 | Hesham Hazin | Internal Medicine | 2604 Saint Michael Dr, Ste 238, Texarkana, TX 75503-2379 | 2009-07-22 |
| 1114173754 | Rajeev Jayendra Patel | Internal Medicine | 2604 Saint Michael Dr, Suite 345, Texarkana, TX 75503-2379 | 2008-08-14 |
| 1356521421 | Kevin Randall Hayes | Internal Medicine | 2604 Saint Michael Dr, Suite 345, Texarkana, TX 75503-2379 | 2007-11-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770049397 | Jeffery Nash | Nurse Practitioner | #4 Valley View Circle, Texarkana, TX 75503 | 2019-02-19 |
| 1821583501 | Brandy D Acker | Psychologist | 3615 Richmond Rd, Texarkana, TX 75503 | 2018-06-26 |
| 1366935066 | Samantha Lee Harris | Nurse Practitioner | 4116 Mcknight Rd, Texarkana, TX 75503 | 2018-06-07 |
| 1811416910 | Heather Alison Gerber | Nurse Practitioner | 5903 Brenda Street, Texarkana, TX 75503 | 2017-09-11 |
| 1952838682 | John Kyle Abney | Counselor | 4134 Mcknight Rd, Texarkana, TX 75503 | 2017-05-12 |
| 1699151514 | Piney Woods Er IIi LLC | Clinic/Center | 4102 Gibson Lane, Texarkana, TX 75503 | 2015-08-03 |
| 1609282433 | Colby Rebecca Pair | Physician Assistant | 2604 St. Michael Dr., Suite 310, Texarkana, TX 75503 | 2014-07-01 |
| 1265842496 | Healthcare Express, LLP | Clinic/Center | 3513 Richmond Rd, Texarkana, TX 75503 | 2014-04-28 |
| 1134540628 | Eagle Dental Center of Texarkana Pllc | Dentist | 4009 Moores Ln, Texarkana, TX 75503 | 2013-12-30 |
| 1326481664 | Juancarlo S. Pascual | Family Medicine | 604 St. Michael Dr, Suite 340, Texarkana, TX 75503 | 2013-04-16 |
| Find all providers in zip 75503 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609282433 | Colby Rebecca Pair | Physician Assistant | 2604 St. Michael Dr., Suite 310, Texarkana, TX 75503 | 2014-07-01 |
| 1962586636 | David A. Godwin | Physician Assistant | 5508 Deer Creek Dr, Texarkana, TX 75503-0012 | 2006-10-25 |
| 1083626493 | Tonya Dubois | Physician Assistant | 3725 Mall Drive, Texarkana, TX 75501-2658 | 2006-08-13 |
| 1508896465 | Katherine Elizabeth Owen | Physician Assistant | 5503 N State Line Ave, Texarkana, TX 75503-5303 | 2006-07-04 |
| 1578558961 | Theresa M Fontenot | Physician Assistant | 3939 Texas Blvd, Texarkana, TX 75503-3207 | 2005-09-13 |
| 1710443544 | Kaylee Keener | Physician Assistant | 3502 Richmond Rd, Texarkana, TX 75503-0705 | 2019-02-17 |
| 1699242347 | Brooke D Carr | Physician Assistant | 1408 College Dr, Texarkana, TX 75503-3534 | 2018-10-31 |
| 1629586573 | Raven Shelby Falls | Physician Assistant | 125 Arkansas Blvd, Texarkana, AR 71854-1963 | 2018-01-12 |
| 1588104590 | Liam Thornell | Physician Assistant | 3515 Richmond Rd, Texarkana, TX 75503-0711 | 2017-02-24 |
| 1265988208 | Kellie Lyn Flaherty | Physician Assistant | 2604 Saint Michael Dr, Suite 340, Texarkana, TX 75503-2379 | 2016-08-30 |
| Find all providers in TEXARKANA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.