Provider Demographics
NPI:1689139891
Name:BIERNACKI, KATRENNAH ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATRENNAH
Middle Name:ANN
Last Name:BIERNACKI
Suffix:
Gender:F
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 1:6222 WEXFORD BRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3926
Mailing Address - Country:US
Mailing Address - Phone:512-966-8051
Mailing Address - Fax:
Practice Address - Street 1:54 GRUENE PARK DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2460
Practice Address - Country:US
Practice Address - Phone:830-625-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant