Provider Demographics
NPI:1609626845
Name:HICKS, SKY IAN (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:SKY
Middle Name:IAN
Last Name:HICKS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BRUMFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1667
Mailing Address - Country:US
Mailing Address - Phone:423-612-3484
Mailing Address - Fax:
Practice Address - Street 1:104 BRUMFIELD CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1667
Practice Address - Country:US
Practice Address - Phone:423-612-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36016363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health