Most Relevant Information
Provider Data
| NPI Number: | 1003502501 |
| Provider Name: | TATE KICKHOEFER |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/17/2023 |
| Last Updated: | 01/22/2024 |
Provider Practice Location
7703 FLOYD CURL DR
SAN ANTONIO
TX
782293901
Practice Location Phone/Fax
| Phone: | 2144989010 |
| Fax: |
Provider Mailing Location
7600 BROADWAY APT 2006
SAN ANTONIO
TX
782091975
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |