Provider Demographics
NPI:1588817621
Name:HICKMAN, KAREN ANDERSON (RN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANDERSON
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 STAR RD
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824-4209
Mailing Address - Country:US
Mailing Address - Phone:803-637-4035
Mailing Address - Fax:803-637-4039
Practice Address - Street 1:21 STAR RD
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-4209
Practice Address - Country:US
Practice Address - Phone:803-637-4035
Practice Address - Fax:803-637-4039
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN078036261QM0801X
SCR66757163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606317BMedicaid
GAGRP0210Medicare PIN