Provider Demographics
NPI:1619286150
Name:MINSKY, MARY MARGARET (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:MINSKY
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 1:2918 LOUIS SESSIONS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-6049
Mailing Address - Country:US
Mailing Address - Phone:870-265-5343
Mailing Address - Fax:870-265-5686
Practice Address - Street 1:2918 LOUIS SESSIONS ST
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-6049
Practice Address - Country:US
Practice Address - Phone:870-265-5343
Practice Address - Fax:870-265-5686
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP-T1015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57428P278OtherBCBS AR
AR1619286150OtherNPI
AR191339795Medicaid
ARP-T1015OtherSTATE LICENSE