Provider Demographics
NPI:1811363773
Name:HICKMAN, RANDI
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:HICKMAN
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 1:14419 GATEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:VA
Mailing Address - Zip Code:23840-2847
Mailing Address - Country:US
Mailing Address - Phone:804-931-6124
Mailing Address - Fax:
Practice Address - Street 1:14419 GATEWOOD RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:VA
Practice Address - Zip Code:23840-2847
Practice Address - Country:US
Practice Address - Phone:804-931-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management