Provider Demographics
NPI:1386876381
Name:POENISCH, KAREN SUE (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:POENISCH
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 WALKING HORSE
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4570
Mailing Address - Country:US
Mailing Address - Phone:210-896-0133
Mailing Address - Fax:
Practice Address - Street 1:8042 WURZBACH RD STE 230
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3806
Practice Address - Country:US
Practice Address - Phone:210-963-6100
Practice Address - Fax:210-461-5060
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81223133VN1004X
IN583390133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric