Provider Demographics
NPI:1417512815
Name:FERNANDEZ, JOAN KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:KATHRYN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 BISSONNET ST APT 4155
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1373
Mailing Address - Country:US
Mailing Address - Phone:903-360-8633
Mailing Address - Fax:
Practice Address - Street 1:2000 DALLAS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4312
Practice Address - Country:US
Practice Address - Phone:214-550-4890
Practice Address - Fax:214-550-4891
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU4506207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program