Provider Demographics
NPI:1508484254
Name:HICKS, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SE COUNTY ROAD 3144
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75109-0689
Mailing Address - Country:US
Mailing Address - Phone:972-955-1881
Mailing Address - Fax:
Practice Address - Street 1:135 SE COUNTY ROAD 3144
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109-0689
Practice Address - Country:US
Practice Address - Phone:972-955-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX949404163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse