Provider Demographics
NPI:1760242929
Name:HICKEY, TAYLOR SUSANNE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SUSANNE
Last Name:HICKEY
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 1:2651 PERKINS CREEK DR APT 223
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7511
Mailing Address - Country:US
Mailing Address - Phone:708-310-2887
Mailing Address - Fax:
Practice Address - Street 1:2651 PERKINS CREEK DR APT 223
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7511
Practice Address - Country:US
Practice Address - Phone:708-310-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program