Provider Demographics
NPI:1619356698
Name:HICKS, CHELSEA NICOLE
Entity Type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:NICOLE
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 1:3758 SUPPER CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LETART
Mailing Address - State:WV
Mailing Address - Zip Code:25253-8469
Mailing Address - Country:US
Mailing Address - Phone:304-593-9518
Mailing Address - Fax:
Practice Address - Street 1:3758 SUPPER CLUB RD
Practice Address - Street 2:
Practice Address - City:LETART
Practice Address - State:WV
Practice Address - Zip Code:25253-8469
Practice Address - Country:US
Practice Address - Phone:304-593-9518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-24
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other