Provider Demographics
NPI:1467495192
Name:HICKS, RHONDA L (FNP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:HICKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4243
Mailing Address - Country:US
Mailing Address - Phone:601-428-8428
Mailing Address - Fax:601-428-8443
Practice Address - Street 1:1420 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4243
Practice Address - Country:US
Practice Address - Phone:601-428-8428
Practice Address - Fax:601-428-8443
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR781325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121348Medicaid
MS0121348Medicaid
MS500000549Medicare ID - Type Unspecified