Provider Demographics
NPI:1023771862
Name:SIKKEMA, CARLA J (PMHNP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:SIKKEMA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:J
Other - Last Name:SIKKEMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6333 DE ZAVALA RD STE A241
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2115
Mailing Address - Country:US
Mailing Address - Phone:210-866-3860
Mailing Address - Fax:
Practice Address - Street 1:2211 S I35 FRONTAGE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741
Practice Address - Country:US
Practice Address - Phone:737-708-7355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057145363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health