Provider Demographics
NPI:1699067645
Name:SISK, RAYMOND EARL
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:EARL
Last Name:SISK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5044
Mailing Address - Country:US
Mailing Address - Phone:573-471-0200
Mailing Address - Fax:573-471-7559
Practice Address - Street 1:102 HOSPITALITY DR
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-9382
Practice Address - Country:US
Practice Address - Phone:573-471-0200
Practice Address - Fax:573-471-7559
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011007020363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care