Provider Demographics
NPI:1568652923
Name:HICKS, REVELL E (RRT, MBA)
Entity Type:Individual
Prefix:MR
First Name:REVELL
Middle Name:E
Last Name:HICKS
Suffix:
Gender:M
Credentials:RRT, MBA
Other - Prefix:
Other - First Name:REVELL
Other - Middle Name:E
Other - Last Name:HICKS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2312 COMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8595
Mailing Address - Country:US
Mailing Address - Phone:817-652-2632
Mailing Address - Fax:
Practice Address - Street 1:2312 COMANCHE TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8595
Practice Address - Country:US
Practice Address - Phone:817-652-2632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242222279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care