Provider Demographics
NPI:1366866931
Name:HICKMAN, LAURA ANN (PMHNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10446 N 74TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1045
Mailing Address - Country:US
Mailing Address - Phone:602-441-2778
Mailing Address - Fax:602-916-0916
Practice Address - Street 1:10446 N 74TH ST STE 140
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:602-441-2778
Practice Address - Fax:602-916-0916
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5445363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1366866931OtherPSYCHIATRY