Provider Demographics
NPI:1447217583
Name:GEORGE, MINI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MINI
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25277
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-5277
Mailing Address - Country:US
Mailing Address - Phone:918-307-6920
Mailing Address - Fax:918-307-6951
Practice Address - Street 1:10501 E 91ST ST
Practice Address - Street 2:SUITE ED
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5790
Practice Address - Country:US
Practice Address - Phone:918-307-6920
Practice Address - Fax:918-307-6951
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1334363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200039230AMedicaid
P00878497OtherMEDICARE RAILROAD
OKOK4044414Medicare PIN
P00878497OtherMEDICARE RAILROAD
Q15249Medicare UPIN