Provider Demographics
NPI:1629515812
Name:HICKMAN, KRISTINE (CRNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:CRNP, FNP-C
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:LAMONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5020
Mailing Address - Country:US
Mailing Address - Phone:410-341-3420
Mailing Address - Fax:
Practice Address - Street 1:505 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5020
Practice Address - Country:US
Practice Address - Phone:410-341-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160049363LF0000X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health