Provider Demographics
NPI:1851754105
Name:HICKMAN PSYCHIATRY OF ARIZONA, PLLC
Entity Type:Organization
Organization Name:HICKMAN PSYCHIATRY OF ARIZONA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:602-441-2778
Mailing Address - Street 1:10446 N 74TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1045
Mailing Address - Country:US
Mailing Address - Phone:602-441-2778
Mailing Address - Fax:602-916-0916
Practice Address - Street 1:10446 N 74TH ST STE 140
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1045
Practice Address - Country:US
Practice Address - Phone:602-441-2778
Practice Address - Fax:602-916-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5445363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ894679Medicaid
AZ1366866931OtherNPI
AZZ165208Medicare PIN