Provider Demographics
NPI:1952650780
Name:HICKS, KANIKA TASHOUN
Entity Type:Individual
Prefix:
First Name:KANIKA
Middle Name:TASHOUN
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 CONGRESS ST SE APT 5
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-5073
Mailing Address - Country:US
Mailing Address - Phone:202-706-4607
Mailing Address - Fax:
Practice Address - Street 1:1330 CONGRESS ST SE APT 5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5073
Practice Address - Country:US
Practice Address - Phone:202-706-4607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide