Provider Demographics
NPI:1508852369
Name:HICKOK, KIMBERLEY X (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:X
Last Name:HICKOK
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 MERRILL LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-1617
Mailing Address - Country:US
Mailing Address - Phone:615-837-2671
Mailing Address - Fax:
Practice Address - Street 1:4815 MERRILL LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-1617
Practice Address - Country:US
Practice Address - Phone:615-837-2671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN127982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3641835Medicare UPIN