Provider Demographics
NPI:1669510152
Name:SIMON, MINDY KAY (PA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:KAY
Last Name:SIMON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 S WESTERN AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2997
Mailing Address - Country:US
Mailing Address - Phone:405-680-5633
Mailing Address - Fax:405-735-6435
Practice Address - Street 1:10001 S WESTERN AVE
Practice Address - Street 2:STE 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2997
Practice Address - Country:US
Practice Address - Phone:405-680-5633
Practice Address - Fax:405-735-6435
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1587363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical