Provider Demographics
NPI:1891954699
Name:HICKS, K MADALYN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:K
Middle Name:MADALYN
Last Name:HICKS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1100
Mailing Address - Country:US
Mailing Address - Phone:417-257-5911
Mailing Address - Fax:417-257-5913
Practice Address - Street 1:181 N KENTUCKY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2089
Practice Address - Country:US
Practice Address - Phone:417-257-5911
Practice Address - Fax:417-257-5913
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008000180363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner