Basic Information
| Provider Information | |||||||||
| NPI: | 1295245603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANSA | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8738 SONORA PASS | ||||||||
| Address2: | |||||||||
| City: | HELOTES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780234481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102627520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16620 N US HIGHWAY 281 STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782322679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103091405 | ||||||||
| FaxNumber: | 2106884596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2017 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP135419 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.