Active NPI
Andrea Pearl Humphreys, OTR/L
- Specialist
- Broken Arrow, OK
National Provider Identifier
1003851114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1231
- Practice address
- 3213 N 8TH PL
Broken Arrow, OK 74012-8221 - Phone
- (918) 894-3700
- NPI assigned
- Jun 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1231 | OK | Primary |
Addresses
Primary practice location
3213 N 8TH PL
Broken Arrow, OK 74012-8221
Mailing address
3213 N 8TH PL
Broken Arrow, OK 74012-8221
Phone (918) 894-3700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200017780 | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1231 | OK | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409270400000",
"number": "1003851114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3213 N 8TH PL",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740128221",
"telephone_number": "918-894-3700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3213 N 8TH PL",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740128221",
"telephone_number": "918-894-3700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMPHREYS",
"first_name": "ANDREA",
"middle_name": "PEARL",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-20",
"last_updated": "2014-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OK",
"license": "1231",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200017780",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.