Provider Demographics
NPI:1134102056
Name:KLEIV, GINA W (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:W
Last Name:KLEIV
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:WELLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5110 MILLIE CT
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5960
Mailing Address - Country:US
Mailing Address - Phone:405-996-6173
Mailing Address - Fax:
Practice Address - Street 1:4009 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2733
Practice Address - Country:US
Practice Address - Phone:325-690-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant