Provider Demographics
NPI:1336904887
Name:HULTZ, KACI LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:LEE
Last Name:HULTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8930 FOURWINDS DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78239
Mailing Address - Country:US
Mailing Address - Phone:210-653-7444
Mailing Address - Fax:210-653-7456
Practice Address - Street 1:8930 FOURWINDS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-1971
Practice Address - Country:US
Practice Address - Phone:210-653-7444
Practice Address - Fax:210-653-7456
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty