Provider Demographics
NPI:1528003886
Name:HICKS, LUCINDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6890 WEST ANDREW JOHNSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8552
Mailing Address - Country:US
Mailing Address - Phone:423-839-2120
Mailing Address - Fax:423-839-2125
Practice Address - Street 1:6890 WEST ANDREW JOHNSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8552
Practice Address - Country:US
Practice Address - Phone:423-839-2120
Practice Address - Fax:423-839-2125
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3644841Medicaid
3644841Medicare PIN