Provider Demographics
NPI:1417054032
Name:HICKMAN, BARBARA L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:L
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MICBETH DRIVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445
Mailing Address - Country:US
Mailing Address - Phone:270-365-1225
Mailing Address - Fax:270-365-1252
Practice Address - Street 1:302 MICBETH DRIVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445
Practice Address - Country:US
Practice Address - Phone:270-365-1225
Practice Address - Fax:270-365-1252
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3645P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006426Medicaid
KY3645POtherLICENSE
000000210255OtherBCBS PROVIDER NUMBER
000000210255OtherBCBS PROVIDER NUMBER
P41965Medicare UPIN
0375290Medicare PIN
KYP400031319Medicare PIN
KY3645POtherLICENSE
KY78006426Medicaid