Healthcare Provider Details

I. General information

NPI: 1609596832
Provider Name (Legal Business Name): KARAH WIATREK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 S PANNA MARIA AVE
KARNES CITY TX
78118-3808
US

IV. Provider business mailing address

310 W OAKLAWN RD
PLEASANTON TX
78064-4033
US

V. Phone/Fax

Practice location:
  • Phone: 830-780-3100
  • Fax: 830-780-3130
Mailing address:
  • Phone: 830-569-8940
  • Fax: 830-224-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1089139
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: