Provider Demographics
NPI:1518476803
Name:HICKMAN, JEAN CAROL (RRT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CAROL
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:TX
Mailing Address - Zip Code:75444-0308
Mailing Address - Country:US
Mailing Address - Phone:903-474-7210
Mailing Address - Fax:
Practice Address - Street 1:1589 CR 2954
Practice Address - Street 2:
Practice Address - City:ALBA
Practice Address - State:TX
Practice Address - Zip Code:75410
Practice Address - Country:US
Practice Address - Phone:903-474-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRCP00076257227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered