Provider Demographics
NPI:1821567686
Name:HICKMAN, RANDI ALEXIS (MSN FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:ALEXIS
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:MRS
Other - First Name:RANDI
Other - Middle Name:ALEXIS
Other - Last Name:TRENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN FNP-C
Mailing Address - Street 1:1080 FOGGY BOTTOM LN
Mailing Address - Street 2:
Mailing Address - City:HILTONS
Mailing Address - State:VA
Mailing Address - Zip Code:24258-6650
Mailing Address - Country:US
Mailing Address - Phone:423-754-4586
Mailing Address - Fax:
Practice Address - Street 1:1180 S BEVERLY DR STE 700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1151
Practice Address - Country:US
Practice Address - Phone:571-585-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily