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General NPI Number Information
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NPI Number | 1801119771
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Entity Type | Individual
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Provider Name | KERBI DAWN ELSENBROEK PA
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Gender | Female
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 12469 TIMBERLAND BLVD # 501
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City | FORT WORTH
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State | TX
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Zip | 76244-6548
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Country | US
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Telephone | 817-431-6555
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Fax | 817-431-7979
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Provider Business Mailing Address
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Address Line | 7920 IRISH DR
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-5741
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Country | US
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Telephone | 817-800-1416
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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 |
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License Number State |
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