Individual
GINA ELIZABETH HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1104 WALNUT DR, ARDMORE, OK 73401-2353
(580) 226-0543
(580) 226-2284
Mailing address
1104 WALNUT DR, ARDMORE, OK 73401-2353
(580) 226-0543
(580) 226-2284
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1401
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200061330A
—
OK
Enumeration date
07/22/2006
Last updated
07/27/2020
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