Provider Demographics
NPI:1649587387
Name:HICKS, BEVILEE S (PA)
Entity Type:Individual
Prefix:
First Name:BEVILEE
Middle Name:S
Last Name:HICKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 HILLCROFT
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057
Mailing Address - Country:US
Mailing Address - Phone:713-782-2286
Mailing Address - Fax:713-782-2290
Practice Address - Street 1:2020 ELDRIDGE PKWY
Practice Address - Street 2:#1302
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3487
Practice Address - Country:US
Practice Address - Phone:713-294-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02933363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical