Provider Demographics
NPI:1497380992
Name:HICKOK, KRISTEN LYNNE (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:LYNNE
Last Name:HICKOK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65751 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-2319
Mailing Address - Country:US
Mailing Address - Phone:760-567-4593
Mailing Address - Fax:
Practice Address - Street 1:1080 N INDIAN CANYON DR STE 203
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4871
Practice Address - Country:US
Practice Address - Phone:760-320-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily