Provider Demographics
NPI:1780796755
Name:VANSICKLE, KAYCIA L (MD)
Entity type:Individual
Prefix:DR
First Name:KAYCIA
Middle Name:L
Last Name:VANSICKLE
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 1:109 W 27TH ST STE 5S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6208
Mailing Address - Country:US
Mailing Address - Phone:917-634-5311
Mailing Address - Fax:
Practice Address - Street 1:1400 N COIT RD STE 302
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6656
Practice Address - Country:US
Practice Address - Phone:865-970-9800
Practice Address - Fax:865-373-8225
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN391992084P0800X
TXJ45842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027315Medicaid
AL331500631Medicaid
557993000OtherMAGELLAN
AL51529598OtherBCBS
630524073OtherTIN # HEALTH CHOICE
557993000OtherMAGELLAN