Healthcare Provider Details

I. General information

NPI: 1366194920
Provider Name (Legal Business Name): MCKENZIE KNAPICK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 LOCKHILL SELMA RD STE 110
SAN ANTONIO TX
78249-4167
US

IV. Provider business mailing address

PO BOX 994
CASTROVILLE TX
78009-0994
US

V. Phone/Fax

Practice location:
  • Phone: 210-492-4300
  • Fax:
Mailing address:
  • Phone: 210-488-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: