Provider Demographics
NPI:1750342895
Name:FENSKE, GINA LUIKA (PA-C)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LUIKA
Last Name:FENSKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LUIKA
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3515 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0711
Mailing Address - Country:US
Mailing Address - Phone:903-791-9355
Mailing Address - Fax:903-831-7258
Practice Address - Street 1:1509 W LOOP 281
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2820
Practice Address - Country:US
Practice Address - Phone:903-759-9355
Practice Address - Fax:903-759-2606
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332685363A00000X
TXPA15808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA053992Medicaid
P56645Medicare UPIN
CA05-1304Medicare ID - Type UnspecifiedLISCENCE NUMBER