Provider Demographics
NPI:1568763217
Name:HICKS, JENNIFER CAMILLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAMILLE
Last Name:HICKS
Suffix:
Gender:F
Credentials:FNP-C
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 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-437-8620
Mailing Address - Fax:325-437-8695
Practice Address - Street 1:3449 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603
Practice Address - Country:US
Practice Address - Phone:325-437-8620
Practice Address - Fax:325-437-8695
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP119403OtherFAMILY NURSE PRACTITIONER