Provider Demographics
NPI:1609110931
Name:GEORGE, REGINA (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10413 GREENBRIAR PKWY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7656
Mailing Address - Country:US
Mailing Address - Phone:405-691-4665
Mailing Address - Fax:405-378-7628
Practice Address - Street 1:10413 GREENBRIAR PKWY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7656
Practice Address - Country:US
Practice Address - Phone:405-691-4665
Practice Address - Fax:405-378-7628
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104916363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health