Provider Demographics
NPI:1992772503
Name:BURCHELL, KAREN D (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:D
Last Name:BURCHELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 MERTON MINTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4404
Mailing Address - Country:US
Mailing Address - Phone:210-616-8385
Mailing Address - Fax:210-616-8383
Practice Address - Street 1:7400 MERTON MINTER ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-616-8385
Practice Address - Fax:210-616-8383
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303016502Medicaid
TX86N141Medicare ID - Type Unspecified
TX303016502Medicaid
TX297151YK00Medicare PIN