Provider Demographics
NPI:1023236304
Name:FAY, KARI HEUSINKVELD (MD)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:HEUSINKVELD
Last Name:FAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:LYNN
Other - Last Name:HEUSINKVELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1305 WONDER WORLD DR STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7541
Mailing Address - Country:US
Mailing Address - Phone:512-396-7575
Mailing Address - Fax:512-396-7555
Practice Address - Street 1:1305 WONDER WORLD DR STE 209
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7541
Practice Address - Country:US
Practice Address - Phone:512-396-7575
Practice Address - Fax:512-396-7555
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8507207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB132303Medicare UPIN