Provider Demographics
NPI:1598936148
Name:HICKS, VICKI HILLIETTA
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:HILLIETTA
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21000 SANDY BROWN LN
Mailing Address - Street 2:
Mailing Address - City:WEBBERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78621-9658
Mailing Address - Country:US
Mailing Address - Phone:512-276-9366
Mailing Address - Fax:
Practice Address - Street 1:21000 SANDY BROWN LN
Practice Address - Street 2:
Practice Address - City:WEBBERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78621-9658
Practice Address - Country:US
Practice Address - Phone:512-276-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider