Provider Demographics
NPI:1205388212
Name:HICKS, CRISTI ANTHONY (NP)
Entity Type:Individual
Prefix:MRS
First Name:CRISTI
Middle Name:ANTHONY
Last Name:HICKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:CRISTI
Other - Middle Name:RENEE
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1388
Mailing Address - Street 2:
Mailing Address - City:HOOKS
Mailing Address - State:TX
Mailing Address - Zip Code:75561-1388
Mailing Address - Country:US
Mailing Address - Phone:903-276-3041
Mailing Address - Fax:
Practice Address - Street 1:1000 PINE ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5100
Practice Address - Country:US
Practice Address - Phone:903-276-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily