Provider Demographics
NPI:1174511265
Name:KIKER, KARLA FUENTES (MD)
Entity type:Individual
Prefix:DR
First Name:KARLA
Middle Name:FUENTES
Last Name:KIKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14041 NORTHWEST BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5138
Mailing Address - Country:US
Mailing Address - Phone:361-767-9963
Mailing Address - Fax:
Practice Address - Street 1:14041 NORTHWEST BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5138
Practice Address - Country:US
Practice Address - Phone:361-767-9963
Practice Address - Fax:361-767-1382
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV1154208000000X
MA2141402080P0207X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2001926Medicaid
MA2001926Medicaid
A35054Medicare ID - Type Unspecified