Individual
DEREK KISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4716 ALLIANCE BLVD STE 600, PLANO, TX 75093-5378
(214) 820-6358
Mailing address
825 CARVER ST, MESQUITE, TX 75149-5011
(830) 637-9849
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
PA15279
TX
363A00000X
Physician Assistant
Primary
PA15279
TX
Other
Enumeration date
01/27/2022
Last updated
11/01/2024
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