Provider Demographics
NPI:1134299332
Name:HICKEY, KARA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:
Last Name:HICKEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MR
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:1740 GUNWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 N HOWARD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3610
Practice Address - Country:US
Practice Address - Phone:301-332-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR135906367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife