Provider Demographics
NPI:1942386776
Name:HICKEY, JOSEPH P (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:HICKEY
Suffix:
Gender:M
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 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-579-3298
Mailing Address - Fax:
Practice Address - Street 1:5820 S. EASTERN
Practice Address - Street 2:LIFESTYLE CENTER
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-797-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001803164W00000X
IL209-005046363LF0000X
WI2167-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1942386776Medicaid
NVV108918OtherSMACC MEDICARE
NVV108918OtherSMACC MEDICARE
ILK49243Medicare UPIN
ILK45062Medicare PIN
NVV108815Medicare PIN