Provider Demographics
NPI:1669727020
Name:WASHKO, AVA KRISTINE (DPM)
Entity type:Individual
Prefix:DR
First Name:AVA
Middle Name:KRISTINE
Last Name:WASHKO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:AVA
Other - Middle Name:KRISTINE
Other - Last Name:WASHKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:119 MEDICAL PARK LN STE D
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4980
Mailing Address - Country:US
Mailing Address - Phone:936-277-1000
Mailing Address - Fax:936-994-9020
Practice Address - Street 1:2502 CANAL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1523
Practice Address - Country:US
Practice Address - Phone:713-224-0555
Practice Address - Fax:713-224-1918
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2138213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX697544OtherMEDICARE PTAN
TX697547OtherMEDICARE PTAN
TX767975OtherMEDICARE PTAN
TX742575OtherMEDICARE PTAN
TX466683OtherMEDICARE PTAN