Provider Demographics
NPI:1568529733
Name:HICKS, ROBERT BRIAN (CSA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRIAN
Last Name:HICKS
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 FOXFIRE RD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9528
Mailing Address - Country:US
Mailing Address - Phone:502-348-2231
Mailing Address - Fax:502-348-2231
Practice Address - Street 1:1144 FOXFIRE RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9528
Practice Address - Country:US
Practice Address - Phone:502-348-2231
Practice Address - Fax:502-348-2231
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA053246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0698960OtherCIGNA
KY000000187994OtherANTHEM
KY0007875244OtherAETNA
KY49-00035OtherUNITED HEALTHCARE