Provider Demographics
NPI:1225149081
Name:HICKEY, CHERYL A (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:HICKEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N MACARTHUR BLVD
Mailing Address - Street 2:#300
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2113
Mailing Address - Country:US
Mailing Address - Phone:972-254-3118
Mailing Address - Fax:972-253-7814
Practice Address - Street 1:2021 N MACARTHUR BLVD
Practice Address - Street 2:#300
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2113
Practice Address - Country:US
Practice Address - Phone:972-254-3118
Practice Address - Fax:972-253-7814
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24888Medicare UPIN
TX81N905Medicare UPIN
TXP00093689Medicare PIN