Provider Demographics
NPI:1609871003
Name:HICKOX, LYNN (NP;CNM)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:HICKOX
Suffix:
Gender:F
Credentials:NP;CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 FRANKLIN PK DR
Mailing Address - Street 2:
Mailing Address - City:E SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-432-1048
Mailing Address - Fax:315-432-9219
Practice Address - Street 1:824 FRANKLIN PK DR
Practice Address - Street 2:
Practice Address - City:E SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-432-1048
Practice Address - Fax:315-432-9219
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000673176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01763193Medicaid
NY000013877OtherBC/BS
NY161529574OtherTAX ID
NY000916155001OtherHEALTHNOW
NY040426015267OtherFIDELIS
NY1899983OtherGHI
NY5626602OtherAETNA
NY161529574OtherTAX ID
NY040426015267OtherFIDELIS