Provider Demographics
NPI:1124541461
Name:PROKOP, JONATHAN WILLIAM
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:PROKOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 BEE CAVES RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ROLLINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5868
Mailing Address - Country:US
Mailing Address - Phone:512-328-7222
Mailing Address - Fax:
Practice Address - Street 1:2700 BEE CAVES RD STE 203
Practice Address - Street 2:
Practice Address - City:ROLLINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:78746-5868
Practice Address - Country:US
Practice Address - Phone:512-328-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134536363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health