Provider Demographics
NPI:1760811095
Name:HICKS, TERESA M (LPN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:HICKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 TWIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2538
Mailing Address - Country:US
Mailing Address - Phone:864-206-6158
Mailing Address - Fax:864-902-3637
Practice Address - Street 1:149 TWIN LAKE RD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2538
Practice Address - Country:US
Practice Address - Phone:864-206-3150
Practice Address - Fax:864-488-0470
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP27334164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse