Provider Demographics
NPI:1942244421
Name:HICKS, KRISTIN DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:DENISE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 QUAKER LN
Mailing Address - Street 2:SUITE 207 C
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-883-2500
Mailing Address - Fax:
Practice Address - Street 1:404 WESTWOOD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4315
Practice Address - Country:US
Practice Address - Phone:336-882-2433
Practice Address - Fax:336-882-2441
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
138JYOtherBCBS
7349137OtherCIGNA
NC89138JYMedicaid
0403382OtherUNITED HEALTHCARE
D6198OtherMEDCOST
7255615OtherAETNA
804914OtherPARTNERS
804914OtherPARTNERS
NC2031389Medicare PIN