Provider Demographics
NPI:1235868944
Name:HICKS, MORGAN D (RDN, LD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:D
Last Name:HICKS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGHWAY 35 N STE 8
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2353
Mailing Address - Country:US
Mailing Address - Phone:501-315-4008
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHWAY 35 N STE 8
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2353
Practice Address - Country:US
Practice Address - Phone:501-315-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2226133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered