Provider Demographics
NPI:1629089396
Name:HICKS, VERONICA MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:MARIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 23RD AVE S APT 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2961
Mailing Address - Country:US
Mailing Address - Phone:206-328-4438
Mailing Address - Fax:
Practice Address - Street 1:1205 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5577
Practice Address - Country:US
Practice Address - Phone:425-690-3474
Practice Address - Fax:425-690-9475
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004943363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical