Provider Demographics
NPI:1497446751
Name:GADDIS, GLIKERIA (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:GLIKERIA
Middle Name:
Last Name:GADDIS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-1405
Mailing Address - Country:US
Mailing Address - Phone:254-371-0914
Mailing Address - Fax:
Practice Address - Street 1:1205 CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-3388
Practice Address - Country:US
Practice Address - Phone:512-556-5362
Practice Address - Fax:512-556-8004
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily