Provider Demographics
NPI:1396708095
Name:HNATEK, JOYCE LYNETTE (MD)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:LYNETTE
Last Name:HNATEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:PENTECOST
Other - Last Name:HNATEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2900 E 29TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2623
Mailing Address - Country:US
Mailing Address - Phone:979-776-8440
Mailing Address - Fax:877-601-5854
Practice Address - Street 1:2900 E 29TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2623
Practice Address - Country:US
Practice Address - Phone:979-776-8440
Practice Address - Fax:877-601-5854
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4409207RH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111436508Medicaid
368120YSCWOtherMEDICARE PTAN
E27655Medicare UPIN
TX5892790001Medicare NSC
TX115190102OtherTEAM CHOICE CORE
TX115190102OtherFIRSTCARE (GRACE CLINIC)
TX8AM634OtherBCBS (GRACE CLINIC)