Healthcare Provider Details

I. General information

NPI: 1386876381
Provider Name (Legal Business Name): KAREN SUE POENISCH R.D., L.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8042 WURZBACH RD STE 230
SAN ANTONIO TX
78229-3806
US

IV. Provider business mailing address

12911 WALKING HORSE
HELOTES TX
78023-4570
US

V. Phone/Fax

Practice location:
  • Phone: 210-963-6100
  • Fax: 210-461-5060
Mailing address:
  • Phone: 210-896-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDT81223
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number583390
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: