Provider Demographics
NPI:1811192560
Name:HICKMAN, ANDREA LEIGH (DO)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:LEIGH
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7481 HIGHWAY 65 69
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-9613
Mailing Address - Country:US
Mailing Address - Phone:515-953-1500
Mailing Address - Fax:
Practice Address - Street 1:7481 HIGHWAY 65 69
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-9613
Practice Address - Country:US
Practice Address - Phone:515-953-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IADO-04828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program