MEDICARE: LUKE PROCHNOW PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA14325	TX

General Provider Information

NPI Number	:	1336733419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE PROCHNOW PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	3750 E PALM VALLEY BLVD UNIT 112
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-3317
Country	:	US
Telephone Number	:	512-350-7706
Fax Number	:

Provider Business Practice Location Address
First Line	:	11005 BURNET RD STE 118
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-4440
Country	:	US
Telephone Number	:	512-229-1535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/01/2021

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