Provider Demographics
NPI:1326449869
Name:OLENICK, KERRY (PA-C)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:OLENICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 LOGWOOD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221
Mailing Address - Country:US
Mailing Address - Phone:210-588-6774
Mailing Address - Fax:210-588-6305
Practice Address - Street 1:527 LOGWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1738
Practice Address - Country:US
Practice Address - Phone:210-588-6774
Practice Address - Fax:210-588-6305
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical