Provider Demographics
NPI:1861484818
Name:VOLK, KENNETH LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEE
Last Name:VOLK
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 1:390 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-9113
Mailing Address - Country:US
Mailing Address - Phone:903-687-2500
Mailing Address - Fax:903-687-3510
Practice Address - Street 1:390 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:WASKOM
Practice Address - State:TX
Practice Address - Zip Code:75692-9113
Practice Address - Country:US
Practice Address - Phone:903-687-2500
Practice Address - Fax:903-687-3510
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01246363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87226Medicare UPIN