Provider Demographics
NPI:1003042060
Name:HICKS, REBEKAH E (PA-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:E
Last Name:HICKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 HOSPITAL PLZ
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9327
Mailing Address - Country:US
Mailing Address - Phone:304-622-2300
Mailing Address - Fax:304-624-9689
Practice Address - Street 1:4 HOSPITAL PLZ
Practice Address - Street 2:SUITE 210
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9327
Practice Address - Country:US
Practice Address - Phone:304-622-2300
Practice Address - Fax:304-624-9689
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV01346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant