Basic Information
| Provider Information | |||||||||
| NPI: | 1669446100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAHNKE | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036414800 | ||||||||
| FaxNumber: | 9036414822 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 HOSPITAL DR | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036414800 | ||||||||
| FaxNumber: | 9036414822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | K1482 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 121233404 | 05 | TX | MEDICAID | 121233406 | 05 | TX | MEDICAID | 8W4548 | 01 | TX | BLUE CROSS | OTHER |