Provider Demographics
NPI:1326681818
Name:HICKEY, ANGIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:
Last Name:HICKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 STANTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3262
Mailing Address - Country:US
Mailing Address - Phone:706-830-7684
Mailing Address - Fax:
Practice Address - Street 1:207 HOLIDAY RD
Practice Address - Street 2:
Practice Address - City:MC CORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835-3430
Practice Address - Country:US
Practice Address - Phone:864-391-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily