Provider Demographics
NPI:1942869912
Name:KIKER, ROBIN M
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:KIKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JARALOSA
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:NM
Mailing Address - Zip Code:88042-9532
Mailing Address - Country:US
Mailing Address - Phone:575-644-5914
Mailing Address - Fax:
Practice Address - Street 1:2701 W PICACHO AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-4732
Practice Address - Country:US
Practice Address - Phone:575-653-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1508221938Medicaid