Provider Demographics
NPI:1619037058
Name:HICKS, MELONY E (WHCNP)
Entity Type:Individual
Prefix:
First Name:MELONY
Middle Name:E
Last Name:HICKS
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:5819 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1636
Practice Address - Country:US
Practice Address - Phone:281-391-7001
Practice Address - Fax:281-391-8175
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256312363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1033060040Medicaid
TX1033060040Medicaid
TXCG2619Medicare PIN
TX8G2587Medicare ID - Type Unspecified
TX1033060040Medicaid
TXS75912Medicare UPIN
TX00112RMedicare PIN