Provider Demographics
NPI:1366799447
Name:SARGENT, MINDY ALEENE (PA)
Entity type:Individual
Prefix:MS
First Name:MINDY
Middle Name:ALEENE
Last Name:SARGENT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 720006
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 BOULDER ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-3801
Practice Address - Country:US
Practice Address - Phone:918-762-2522
Practice Address - Fax:918-762-3510
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2149363AS0400X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200447890AMedicaid
OK337533YK6XMedicare PIN