Provider Demographics
NPI:1376933150
Name:HICKERSON, LINDSEY (APRN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-9432
Mailing Address - Country:US
Mailing Address - Phone:270-524-3641
Mailing Address - Fax:
Practice Address - Street 1:1134 MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9432
Practice Address - Country:US
Practice Address - Phone:270-524-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3009233OtherKENTUCKY BOARD OF NURSING
KYK190171Medicare PIN
KYK190170Medicare PIN