Provider Demographics
NPI:1396511960
Name:RADER, GINGER ALICE (PA)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:ALICE
Last Name:RADER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:ALICE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1226 N SHARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2421
Mailing Address - Country:US
Mailing Address - Phone:405-232-8003
Mailing Address - Fax:
Practice Address - Street 1:1226 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2421
Practice Address - Country:US
Practice Address - Phone:405-232-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant