Provider Demographics
NPI:1184754012
Name:NISCHIK, KIMBERLY D (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:NISCHIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:PROHASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:775 FLEISCHMANN WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2995
Mailing Address - Country:US
Mailing Address - Phone:775-445-7756
Mailing Address - Fax:775-841-0304
Practice Address - Street 1:775 FLEISCHMANN WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2995
Practice Address - Country:US
Practice Address - Phone:775-445-7756
Practice Address - Fax:775-841-0304
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00388541OtherRAILROAD MEDICARE
NVQ78629Medicare UPIN
V103751Medicare PIN