Provider Demographics
NPI:1649385972
Name:FELKLEY, KENNETH E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:E
Last Name:FELKLEY
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 1:7738 BRISBANE BND
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1965
Mailing Address - Country:US
Mailing Address - Phone:210-831-7912
Mailing Address - Fax:
Practice Address - Street 1:3351 ROGER BROOKE DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-9000
Practice Address - Country:US
Practice Address - Phone:210-831-7912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50. 001827363A00000X
PAMA051218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant