Provider Demographics
NPI:1770739542
Name:KUBISTA, NIKOLAUS SEBASTIAN (DO)
Entity type:Individual
Prefix:
First Name:NIKOLAUS
Middle Name:SEBASTIAN
Last Name:KUBISTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5154
Mailing Address - Country:US
Mailing Address - Phone:830-896-2211
Mailing Address - Fax:
Practice Address - Street 1:721 THOMPSON DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5154
Practice Address - Country:US
Practice Address - Phone:830-896-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP41962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry