Provider Demographics
NPI:1205180585
Name:HICKS, MENDY A (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MENDY
Middle Name:A
Last Name:HICKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3932 STEPHENS RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CANE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4582
Mailing Address - Country:US
Mailing Address - Phone:615-293-7817
Mailing Address - Fax:615-941-8502
Practice Address - Street 1:5801 CROSSINGS BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3130
Practice Address - Country:US
Practice Address - Phone:615-941-8501
Practice Address - Fax:615-941-8502
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily