Provider Demographics
NPI:1871003608
Name:HICKS, JAMI LYNN (PNP)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:LYNN
Last Name:HICKS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GENE SAMFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3359
Mailing Address - Country:US
Mailing Address - Phone:936-634-2214
Mailing Address - Fax:
Practice Address - Street 1:1375 N DICKINSON DR
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1051
Practice Address - Country:US
Practice Address - Phone:936-634-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20173207208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics