Provider Demographics
NPI:1700046810
Name:KISSOON, NATALIE NIKEISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:NIKEISHA
Last Name:KISSOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-704-3800
Mailing Address - Fax:
Practice Address - Street 1:315 N SAN SABA
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3154
Practice Address - Country:US
Practice Address - Phone:210-704-3800
Practice Address - Fax:210-704-0065
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD140022080C0008X
TXQ3904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346780501Medicaid
TX417103YK00Medicare PIN