Provider Demographics
NPI:1043098049
Name:WIECHNICKI, KATHERINE POFF (RN, CDCES)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:POFF
Last Name:WIECHNICKI
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 WEST PARMER LANE,
Mailing Address - Street 2:SUITE 370 PMB# 71
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3908
Mailing Address - Country:US
Mailing Address - Phone:713-542-5935
Mailing Address - Fax:
Practice Address - Street 1:6704 HONDO BND
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7509
Practice Address - Country:US
Practice Address - Phone:713-542-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX731625163WD0400X
171400000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No171400000XOther Service ProvidersHealth & Wellness Coach