Provider Demographics
NPI:1558393827
Name:CAMPBELL, MINDIE JOYCE (PA)
Entity Type:Individual
Prefix:
First Name:MINDIE
Middle Name:JOYCE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MINDIE
Other - Middle Name:JOYCE
Other - Last Name:MEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 SOUTH PEORIA AVE
Mailing Address - Street 2:INDIAN HEALTH CARE RESOURSE CENTER OF TULSA, INC
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3820
Mailing Address - Country:US
Mailing Address - Phone:918-588-1900
Mailing Address - Fax:918-582-6405
Practice Address - Street 1:550 SOUTH PEORIA AVE
Practice Address - Street 2:INDIAN HEALTH CARE RESOURSE CENTER OF TULSA, INC
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:918-582-6405
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1065994363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1601417Medicaid
OK1601417Medicaid
A44169Medicare UPIN