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General NPI Number Information
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NPI Number | 1336733419
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Entity Type | Individual
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Provider Name | LUKE PROCHNOW PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 11005 BURNET RD STE 118
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City | AUSTIN
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State | TX
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Zip | 78758-4440
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Country | US
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Telephone | 512-229-1535
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 E PALM VALLEY BLVD UNIT 112
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City | ROUND ROCK
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State | TX
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Zip | 78665-3317
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Country | US
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Telephone | 512-350-7706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA14325
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License Number State | TX
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