Healthcare Provider Details

I. General information

NPI: 1861276941
Provider Name (Legal Business Name): KELCIE F GINN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELCIE HUGHES PA-C

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S WHEELING AVE
TULSA OK
74104-5649
US

IV. Provider business mailing address

1923 S UTICA AVE
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-3131
  • Fax: 918-403-6335
Mailing address:
  • Phone: 844-272-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5730
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: