MEDICARE: DAWN HOLLEY KIKER FNP

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	363LF0000X	Family Nurse Practitioner	R863932	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	25-3808	OTHER		MEDICARE NEWTON OFFICE
5	25-3841	OTHER		MEDICARE MERIDIAN OFFICE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588895080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN HOLLEY KIKER FNP

Provider Business Mailing Address
First Line	:	9425 EASTSIDE DRIVE EXT
Second Line	:	SUITE A
City	:	NEWTON
State	:	MS
Zip	:	39345-8068
Country	:	US
Telephone Number	:	601-635-3333
Fax Number	:	601-635-3330

Provider Business Practice Location Address
First Line	:	4711 POPLAR SPRINGS DR
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-2622
Country	:	US
Telephone Number	:	601-425-7777
Fax Number	:

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

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	04/25/2013

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Directions to “ DAWN HOLLEY KIKER FNP” Practice Location

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