Provider Demographics
NPI:1588895080
Name:KIKER, DAWN HOLLEY (FNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:HOLLEY
Last Name:KIKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:KIKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9425 EASTSIDE DRIVE EXT
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-8068
Mailing Address - Country:US
Mailing Address - Phone:601-635-3333
Mailing Address - Fax:601-635-3330
Practice Address - Street 1:4711 POPLAR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2622
Practice Address - Country:US
Practice Address - Phone:601-425-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04278332OtherMEDICAID GROUP NEWTON
25-3808OtherMEDICARE NEWTON OFFICE
MS5859009Medicaid
MS00925081OtherMEDICAID GROUP MERIDIAN
25-3841OtherMEDICARE MERIDIAN OFFICE