Provider Demographics
NPI:1932695764
Name:HICKS, MICHAELA KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:KATHERINE
Last Name:HICKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6729 KERNEL CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-1817
Mailing Address - Country:US
Mailing Address - Phone:443-758-6146
Mailing Address - Fax:
Practice Address - Street 1:144 S 8TH ST STE 110
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2752
Practice Address - Country:US
Practice Address - Phone:717-504-8149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7130207R00000X
MDC07208363AM0700X
PAMA063837363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine