Provider Demographics
NPI:1689855702
Name:HICKS, KEVIN RICHARD (LSW, IS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RICHARD
Last Name:HICKS
Suffix:
Gender:M
Credentials:LSW, IS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-0492
Mailing Address - Country:US
Mailing Address - Phone:870-269-8100
Mailing Address - Fax:870-269-2196
Practice Address - Street 1:211 BLANCHARD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-0492
Practice Address - Country:US
Practice Address - Phone:870-269-8100
Practice Address - Fax:870-269-2196
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2662-BOtherSOCIAL WORKER LIC. BOARD