Provider Demographics
NPI:1902863244
Name:FICKETT, THOMAS E (NP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:FICKETT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 GARDENVILLE PKWY W
Mailing Address - Street 2:ATTN: BETTY PICCILLO
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1324
Mailing Address - Country:US
Mailing Address - Phone:716-857-6150
Mailing Address - Fax:716-656-4074
Practice Address - Street 1:151 ELMVIEW AVENUE
Practice Address - Street 2:HAMBURG HEALTH CENTER
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075
Practice Address - Country:US
Practice Address - Phone:716-648-3040
Practice Address - Fax:716-656-4254
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3001571363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426003266OtherFIDELIS CARE
NY000560333004OtherBCBS OF WNY
NY10767637OtherCAQH
NY9590202OtherIHA
NY177020BJOtherPREFERRED CARE
NYP00186991OtherMEDICARE RAILROAD
NY10767637OtherCAQH
S67064Medicare UPIN