Provider Demographics
NPI:1003197104
Name:HICKS, ERICA NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:NICOLE
Last Name:HICKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LYSTER ARMY HEALTH CLINIC
Mailing Address - Street 2:BULIDING 301 ANDREWS AVE
Mailing Address - City:FT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7000
Mailing Address - Fax:
Practice Address - Street 1:LYSTER ARMY HEALTH CLINIC
Practice Address - Street 2:BULIDING 301 ANDREWS AVE
Practice Address - City:FT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-062689164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse