Provider Demographics
NPI:1821699497
Name:HICKS, ERICA FERGUSON (NP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:FERGUSON
Last Name:HICKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2930
Mailing Address - Country:US
Mailing Address - Phone:913-961-7282
Mailing Address - Fax:
Practice Address - Street 1:4500 MERCANTILE PLAZA DR STE 204
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4225
Practice Address - Country:US
Practice Address - Phone:949-891-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX843286163W00000X
TX1011769363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse