Provider Demographics
NPI:1164796926
Name:HANEBRINK, KIMBERLY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:HANEBRINK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:SYNATZSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17099 N TEXAS AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4069
Mailing Address - Country:US
Mailing Address - Phone:281-332-4575
Mailing Address - Fax:281-554-4722
Practice Address - Street 1:17099 N TEXAS AVE
Practice Address - Street 2:STE. 200
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4069
Practice Address - Country:US
Practice Address - Phone:281-332-4575
Practice Address - Fax:281-554-4722
Is Sole Proprietor?:No
Enumeration Date:2012-02-26
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8599NFOtherBCBS
TX328568601Medicaid
TX327037YKQHMedicare PIN