Provider Demographics
NPI:1164989075
Name:BIRKNER, JUSTIN WADE (NP-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WADE
Last Name:BIRKNER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 STRAWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1760
Mailing Address - Country:US
Mailing Address - Phone:713-477-8600
Mailing Address - Fax:713-477-8604
Practice Address - Street 1:3230 STRAWBERRY RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1760
Practice Address - Country:US
Practice Address - Phone:713-477-8600
Practice Address - Fax:713-477-8604
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140782363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner