MEDICARE: KIRSTEN FIKES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA06863	TX

General Provider Information

NPI Number	:	1760737126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN FIKES PA-C

Provider Business Mailing Address
First Line	:	3107 TPC PKWY STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2396
Country	:	US
Telephone Number	:	210-240-4854
Fax Number	:	830-438-1842

Provider Business Practice Location Address
First Line	:	3107 TPC PKWY STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2396
Country	:	US
Telephone Number	:	210-240-4854
Fax Number	:	830-438-1842

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	07/20/2012

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Directions to “ KIRSTEN FIKES PA-C” Practice Location

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