Active NPI
Kisito N Kikam
- Pharmacist
- Jonesboro, AR
National Provider Identifier
1568905495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD12515
- Practice address
- 108 E Highland Dr
Jonesboro, AR 72401-5940 - Phone
- (870) 802-3749
- NPI assigned
- Nov 26, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD12515 | AR | Primary |
| Pharmacist | 183500000X | 03-2-33562 | OH | |
| Pharmacist | 183500000X | 24001 | NC |
Addresses
Primary practice location
108 E Highland Dr
Jonesboro, AR 72401-5940
Mailing address
1500 W Kingshighway
Paragould, AR 72450-4009
Phone (870) 240-8053
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD12515 | AR | MD | Pharmacist |
| 24001 | NC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480118400000",
"number": "1568905495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 W KINGSHIGHWAY",
"city": "PARAGOULD",
"state": "AR",
"postal_code": "724504009",
"telephone_number": "870-240-8053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 E HIGHLAND DR",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724015940",
"telephone_number": "870-802-3749"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIKAM",
"first_name": "KISITO",
"middle_name": "N",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-26",
"last_updated": "2016-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD12515",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03-2-33562",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "24001",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.