Provider Demographics
NPI:1841804580
Name:HICKMAN, KAILEY MARIE
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:MARIE
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 1:1478 HELENS RUN RD
Mailing Address - Street 2:
Mailing Address - City:IDAMAY
Mailing Address - State:WV
Mailing Address - Zip Code:26576
Mailing Address - Country:US
Mailing Address - Phone:304-694-5645
Mailing Address - Fax:
Practice Address - Street 1:1478 HELENS RUN RD
Practice Address - Street 2:
Practice Address - City:IDAMAY
Practice Address - State:WV
Practice Address - Zip Code:26576
Practice Address - Country:US
Practice Address - Phone:304-694-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant