Kenneth I Licker, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

F7819 Issued in TX

Practice address

935 York Dr
Desoto, TX 75115-2043

Phone

(817) 784-0818

Fax

(972) 709-5920

NPI assigned

Sep 20, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Medical Clinic of North Texas PLLC

  • Radiation Oncology Clinic/Center
  • Arlington, TX
  • NPI 1184131625
  NPD (past)
• Urology Associates of North Texas LLP

  • Urology Physician
  • Weatherford, TX
  • NPI 1407849961
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255046400000",
    "number": "1891781316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120549",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760120549",
            "telephone_number": "817-303-4521",
            "fax_number": "972-709-5920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 YORK DR",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152043",
            "telephone_number": "817-784-0818",
            "fax_number": "972-709-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICKER",
        "first_name": "KENNETH",
        "middle_name": "I",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2009-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TX",
            "license": "F7819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114910602",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114910601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Regina Levine, LCSW
• Brittany Lewis, LVN
• Jason Lewis
• Liberty Ambulance Services, Inc
• Liberty Healthcare Inc
• Philip Lieu, M.D.
• Life 2.0 Behavioral Health Services
• Life Changing Solutions, LLC
• Lisa a. King M.D,P.a.
• Gene Edward Little Jr.

• Urology Physician in Desoto, TX
• Providers in Desoto, TX by specialty
• Urology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.