Provider Demographics
NPI:1770510976
Name:KIKER, JOHN (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KIKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 S EXPRESSWAY 77
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3213
Mailing Address - Country:US
Mailing Address - Phone:956-428-5522
Mailing Address - Fax:956-421-2759
Practice Address - Street 1:500 E RIDGE RD
Practice Address - Street 2:STE 101
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1506
Practice Address - Country:US
Practice Address - Phone:956-686-5226
Practice Address - Fax:956-618-3051
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352906701Medicaid
TX352906701Medicaid
TX528839YUQGMedicare PIN