Provider Demographics
NPI:1689645236
Name:KEMPER, KAREN CERVENKA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:CERVENKA
Last Name:KEMPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:CERVENKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5338
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-0338
Mailing Address - Country:US
Mailing Address - Phone:254-202-4630
Mailing Address - Fax:254-741-6846
Practice Address - Street 1:2201 MACARTHUR DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3161
Practice Address - Country:US
Practice Address - Phone:254-202-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3513208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A8892OtherBCBS
TX133476507Medicaid
TX133476507Medicaid
E80746Medicare UPIN