Basic Information
| Provider Information | |||||||||
| NPI: | 1023771862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIKKEMA | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PMHNP | ||||||||
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| OtherLastName: | SIKKEMA | ||||||||
| OtherFirstName: | CARLA | ||||||||
| OtherMiddleName: | J | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 923 10TH ST | ||||||||
| Address2: | PMB 209 | ||||||||
| City: | FLORESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781141870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107221549 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 HAVEN FOR HOPE WAY | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782071266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102202100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2021 | ||||||||
| LastUpdateDate: | 11/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 1057145 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.