Provider Demographics
NPI:1588017297
Name:HICKS FAMILY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HICKS FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:712-330-7842
Mailing Address - Street 1:1004 21ST ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MILFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51351-7421
Mailing Address - Country:US
Mailing Address - Phone:712-338-6220
Mailing Address - Fax:712-338-6221
Practice Address - Street 1:1004 21ST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351-7421
Practice Address - Country:US
Practice Address - Phone:712-338-6220
Practice Address - Fax:712-338-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA100828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty