Provider Demographics
NPI:1346440997
Name:HICKS, SABRINA (RD, LD)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0247
Mailing Address - Country:US
Mailing Address - Phone:606-377-3415
Mailing Address - Fax:606-377-3453
Practice Address - Street 1:9788 KY ROUTE 122
Practice Address - Street 2:
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-6025
Practice Address - Country:US
Practice Address - Phone:606-377-3415
Practice Address - Fax:606-377-3453
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-KY-1959133V00000X
KY951233133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered