Provider Demographics
NPI:1396634614
Name:HICKS, WILLARD EUGENE
Entity type:Individual
Prefix:
First Name:WILLARD
Middle Name:EUGENE
Last Name:HICKS
Suffix:
Gender:X
Credentials:
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 274
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24873-0274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:58 JOHN R HICKS RD
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:WV
Practice Address - Zip Code:24873
Practice Address - Country:US
Practice Address - Phone:859-274-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide