Provider Demographics
NPI:1891313169
Name:MISHKIN, GEORGINA (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:MISHKIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GEORGINA
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-307-3170
Mailing Address - Fax:
Practice Address - Street 1:10505 E 91ST ST STE 203
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5829
Practice Address - Country:US
Practice Address - Phone:918-307-3120
Practice Address - Fax:918-307-3121
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical