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General NPI Number Information
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NPI Number | 1619286150
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Entity Type | Individual
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Provider Name | MARY MARGARET MINSKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 2918 LOUIS SESSIONS ST
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City | LAKE VILLAGE
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State | AR
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Zip | 71653-6049
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Country | US
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Telephone | 870-265-5343
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Fax | 870-265-5686
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Provider Business Mailing Address
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Address Line | 2918 LOUIS SESSIONS ST
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City | LAKE VILLAGE
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State | AR
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Zip | 71653-6049
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Country | US
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Telephone | 870-265-5343
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Fax | 870-265-5686
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | P-T1015
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License Number State | AR
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