Healthcare Provider Details

I. General information

NPI: 1184754012
Provider Name (Legal Business Name): KIMBERLY D NISCHIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY D PROHASKA PA-C

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W LIBERTY ST STE LL2
RENO NV
89501-2067
US

IV. Provider business mailing address

201 W LIBERTY ST STE LL2
RENO NV
89501-2067
US

V. Phone/Fax

Practice location:
  • Phone: 775-525-8103
  • Fax: 775-525-8105
Mailing address:
  • Phone: 775-525-8103
  • Fax: 775-525-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA947
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: