Provider Demographics
NPI:1346427614
Name:HICKMAN, LINDSAY (PA)
Entity Type:Individual
Prefix:PROF
First Name:LINDSAY
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N IH 35
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8320
Mailing Address - Fax:
Practice Address - Street 1:1400 N IH 35
Practice Address - Street 2:SUITE 320
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1926
Practice Address - Country:US
Practice Address - Phone:512-324-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05592363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195908201Medicaid
TX195908202Medicaid
TX195908206Medicaid
TX195908208Medicaid
TX8Y8381OtherBCBS
TX8Y8449OtherBCBSTX
TX195908209Medicaid
TX195908211Medicaid
TX195908210Medicaid
TX195908212Medicaid
TX195908207Medicaid
TX338875YS07Medicare PIN
TX338875YL9XMedicare PIN
TX8K8739Medicare PIN
TX195908201Medicaid
TX195908208Medicaid
TX195908212Medicaid
TX338875YKZJMedicare PIN
TX8Y8449OtherBCBSTX