MEDICARE: MRS. KALLIE BLYTHE HUMPHREYS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	APA2188	OK
2	363A00000X	Physician Assistant	2188	OK

General Provider Information

NPI Number	:	1194061143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KALLIE BLYTHE HUMPHREYS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 269032
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9032
Country	:	US
Telephone Number	:	405-951-2545
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 NW EXPRESSWAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4999
Country	:	US
Telephone Number	:	405-949-3011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2012
Last Update Date	:	06/08/2022

Similar Medicare Providers

1215891031 — KATHERINE HENSON
Practice Location Address:

3300 NW EXPWY BLDG C
OKLAHOMA CITY, OK
73112-4999

Practice Phone: 405-949-3349
Practice Fax:

1811251283 — DR. JOSEPH MICHAEL BREWER D.O.
Practice Location Address:

3300 NW EXPRESSWAY
OKLAHOMA CITY, OK
73112-4999

Practice Phone: 405-949-3349
Practice Fax:

1558744037 — RAVI D PATEL
Practice Location Address:

3300 NW EXPRESSWAY
OKLAHOMA CITY, OK
73112-4999

Practice Phone: 405-949-3011
Practice Fax:

1528443876 — DR. AHMED ALSAEI M.D
Practice Location Address:

3300 NW EXPWY
OKLAHOMA CITY, OK
73112-4999

Practice Phone: 405-949-3011
Practice Fax:

1871081109 — MEAGAN ELIZABETH BALLARD RD/LD
Practice Location Address:

3300 NW EXPRESSWAY
OKLAHOMA CITY, OK
73112-4999

Practice Phone: 918-406-2343
Practice Fax:

1053804112 — MRS. TAYLOR BROOKE HERZER PA-C
Practice Location Address:

3300 NW EXPWY
OKLAHOMA CITY, OK
73112-4999

Practice Phone: 405-949-3011
Practice Fax:

Directions to “ MRS. KALLIE BLYTHE HUMPHREYS PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.