Provider Demographics
NPI:1952460750
Name:HANZIK, KAVIN G (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:KAVIN
Middle Name:G
Last Name:HANZIK
Suffix:
Gender:M
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:501 W MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4219
Practice Address - Country:US
Practice Address - Phone:281-332-7505
Practice Address - Fax:281-332-7616
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199702502Medicaid
TX199702503Medicaid
TX8Y1279OtherBCBS
TXP01880001OtherRAILROAD