Provider Demographics
NPI:1093578361
Name:HICKS, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 SPRING RUN RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLDSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25234-7089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:749 SPRING RUN RD
Practice Address - Street 2:
Practice Address - City:ARNOLDSBURG
Practice Address - State:WV
Practice Address - Zip Code:25234-7089
Practice Address - Country:US
Practice Address - Phone:681-274-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant