Provider Demographics
NPI:1720396633
Name:GENTY, ALEXANDER R (ARNP)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:R
Last Name:GENTY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-5875
Mailing Address - Country:US
Mailing Address - Phone:806-402-0123
Mailing Address - Fax:
Practice Address - Street 1:405 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-5875
Practice Address - Country:US
Practice Address - Phone:806-402-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK81255363LF0000X
TX805930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily