Provider Demographics
NPI:1780838136
Name:STICKA, KAREN S (PA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:STICKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:HIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:804 NE MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4653
Mailing Address - Country:US
Mailing Address - Phone:817-595-4500
Mailing Address - Fax:817-595-4505
Practice Address - Street 1:804 NE MALL BLVD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4653
Practice Address - Country:US
Practice Address - Phone:817-595-4500
Practice Address - Fax:817-595-4505
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297241601Medicaid
TX297241602Medicaid
TXP00991907OtherRAILROAD
TX297241602Medicaid
TXTXB124266Medicare PIN
TXTXB124265Medicare PIN