Provider Demographics
NPI:1003014549
Name:HICKS, KRISTIN LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LYNN
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 SE OCEAN BLVD STE 145
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3310
Mailing Address - Country:US
Mailing Address - Phone:772-349-9304
Mailing Address - Fax:561-768-4031
Practice Address - Street 1:12300 ALTERNATE A1A STE 116
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2211
Practice Address - Country:US
Practice Address - Phone:772-349-9304
Practice Address - Fax:561-768-4031
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1139372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG0856YMedicare PIN
FLG0856YMedicare PIN