MEDICARE: JOAN KATHRYN FERNANDEZ MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207N00000X	Dermatology Physician	U4506	TX

General Provider Information

NPI Number	:	1417512815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN KATHRYN FERNANDEZ MD

Provider Business Mailing Address
First Line	:	2630 BISSONNET ST APT 4155
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1373
Country	:	US
Telephone Number	:	903-360-8633
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 DALLAS PKWY STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4312
Country	:	US
Telephone Number	:	214-550-4890
Fax Number	:	214-550-4891

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

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	04/10/2024

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