Provider Demographics
NPI:1073037735
Name:HICKS, ASHLEY (LPN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
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 1:5972 HAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-9093
Mailing Address - Country:US
Mailing Address - Phone:252-567-6814
Mailing Address - Fax:
Practice Address - Street 1:5972 HAYWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27856
Practice Address - Country:US
Practice Address - Phone:252-567-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79472164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse