Provider Demographics
NPI:1134310824
Name:HICKMAN, KIMBERLY R (CNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 KEITH DR
Mailing Address - Street 2:STE A
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4952
Mailing Address - Country:US
Mailing Address - Phone:740-751-5516
Mailing Address - Fax:
Practice Address - Street 1:1019 KEITH DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4951
Practice Address - Country:US
Practice Address - Phone:478-988-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 09489363LF0000X
GA237831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily