Provider Demographics
NPI:1033148150
Name:SENKEL, CHRYSTYNA KAULBACH (PA)
Entity Type:Individual
Prefix:
First Name:CHRYSTYNA
Middle Name:KAULBACH
Last Name:SENKEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRYSTYNA
Other - Middle Name:ANNE
Other - Last Name:KAULBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-735-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02258363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8972NHOtherBCBS
TX181538303Medicaid
TX8972NHOtherBCBS
TX8L16188Medicare PIN