Provider Demographics
NPI:1912155185
Name:MIKESKA, SUSAN KAY (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:MIKESKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15562 BROOKHOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5200
Mailing Address - Country:US
Mailing Address - Phone:972-564-1418
Mailing Address - Fax:
Practice Address - Street 1:238 W 10TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4523
Practice Address - Country:US
Practice Address - Phone:214-942-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-30
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily