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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Sunday, December 22, 2024 6:44 PM CST
Next Update: Monday, December 23, 2024 2:50 AM CST

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HUMPHREYS, KALLIE BLYTHE       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: OU MEDICAL CENTER
700 NE 13TH ST
OKLAHOMA CITY OK 73104

Address last updated on 2/2/2024
Phone #: (405) 341-6100
Fax #:
County: OKLAHOMA
License: 2188
Dated: 1/10/2013
Expires: 3/31/2025
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
OU MEDICAL CENTER
700 NE 13TH ST
OKLAHOMA CITY OK 73104

Phone #: (405) 341-6100
Fax #:

Hospital Privileges:

INTEGRIS Baptist Medical Center
Oklahoma City, OK
INTEGRIS Baptist Portland Ave (fmly Deaconess Hospital)
Oklahoma City, OK
OU Health Medical Center
Oklahoma City, OK
OU Medical Center - Edmond
Edmond, OK
Share Medical Center
Alva, OK
SSM St Anthony Midwest Regional Medical Center
Midwest City, OK

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
JOEL WILLIAM ANDERSON III MD 16163
ERIK ANGLES MD 29780
EDWARD RAYMOND ARMSTRONG MD 17271
CHRISTOPHER BARNETT ARNOLD MD 31328
CURTIS ERROL BALL DO 3932
MATTHEW RAY BONNER MD 24385
HERSCHEL LAWRENCE BROWN MD 18034
MATTHEW DAVID CAUDLE MD 26822
SCOTT ALLEN CHAPPELL MD 24268
CHARLES ROGER COBB MD 11789
GARY DON CONRAD MD 11784
BRIAN COOK DO 3253
ROBERT LEWIS CUNNINGHAM III MD 26843
BRETT WILLIAM DERREVERE MD 32738
DAVID RYAN FISH MD 26914
Levi James Garrison DO 6167
RICHARD BRUCE HEIGLE MD 17668
JESSICA DAWN HILDEBRAND MD 24769
MICHAEL VON KALCICH MD 18986
JOHN CHARLES KAUFMAN MD 30699
CHRISTOPHER KEITH KELSO MD 31447
ERIN POWERS KINNEY DO 5400
SHELTON KNUDSEN DO 5582
RACHEL E LaFORTUNE MD 25247
SANG LEE DO 3864
COLBY D. MAYO DO 4029
PETER FREDERICK MCLAUGHLIN MD 21569
TYLER JOANNA MORGAN MD 28341
LOC KIM NGO MD 21508
TAM MINH NGUYEN MD 33346
MICHAEL DAVID PADGHAM MD 17682
JOSHUA RUSH PAYNE MD 28348
DILLON JACK ROACH MD 26891
SCOTT EDWIN ROGERS MD 27262
ANGELA L SELMON MD 17207
JEFFREY MYLES SPARKMAN MD 25930
STEPHANIE JAYNE TOTH MD 25091
ANDREW VUONG MD 24161
KEVIN LYLE WHITE MD 23997
GISELLE ZAGARI STUPPIELLO MD 34613

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