Provider Demographics
NPI:1306843818
Name:HICKS, JAMIE L (CNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:HICKS
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 1:1004 21ST ST UNIT 2
Mailing Address - Street 2:PO BOX 208
Mailing Address - City:MILFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51351-7421
Mailing Address - Country:US
Mailing Address - Phone:712-338-6220
Mailing Address - Fax:712-338-6221
Practice Address - Street 1:1004 21ST ST UNIT 2
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351-7421
Practice Address - Country:US
Practice Address - Phone:712-338-6220
Practice Address - Fax:712-338-6221
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA100828363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN797682800Medicaid
MN797682800Medicaid
P95792Medicare UPIN