Provider Demographics
NPI:1548585698
Name:HICKEY, KATHLEEN (CD(DONA))
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HICKEY
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 SANDIA RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9074
Mailing Address - Country:US
Mailing Address - Phone:260-437-8094
Mailing Address - Fax:
Practice Address - Street 1:4419 SANDIA RUN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9074
Practice Address - Country:US
Practice Address - Phone:260-437-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula