Provider Demographics
NPI:1588029383
Name:MALONEY, GINA NICOLE (MHS, PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:NICOLE
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:NICOLE
Other - Last Name:LEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 26901
Mailing Address - Street 2:WP 1290
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:SUITE 4200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant