Provider Demographics
NPI:1932702073
Name:HICKS, DESEREE MARIE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:DESEREE
Middle Name:MARIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:DESEREE
Other - Middle Name:MARIE
Other - Last Name:HUBBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10630 BUCK PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3450
Mailing Address - Country:US
Mailing Address - Phone:210-772-8087
Mailing Address - Fax:
Practice Address - Street 1:8700 CROWNHILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1128
Practice Address - Country:US
Practice Address - Phone:210-824-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX929941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse