Provider Demographics
NPI:1437156130
Name:HICKS, STEPHEN BRYAN (PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BRYAN
Last Name:HICKS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S MAIN ST
Mailing Address - Street 2:114
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2833
Mailing Address - Country:US
Mailing Address - Phone:830-816-6844
Mailing Address - Fax:830-816-6922
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:114
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2833
Practice Address - Country:US
Practice Address - Phone:830-816-6844
Practice Address - Fax:830-816-6922
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00853363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical