| Doctor Name: | DONNA MARIE PROKOP-FETTIG |
| NPI Number: | 1013153147 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A.-C |
| License Number: | PA06103 |
| Business Practice Address: | 1201 Sam Bass Rd Round Rock, TX - 786814137 |
| Business Phone Number: | 5123881861 |
| Business Fax Number: | 5123880373 |
| Mailing Address: | Po Box 268945, OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731268945 |
| Phone Number: | 5123881861 |
| Fax Number: | 5123880373 |
| NPI Enumeration Date: | 12/18/2008 |
| NPI Last Update Date: | 09/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA06103 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |