Provider Demographics
NPI:1023163474
Name:HICKSON, STERLING C (PA-C)
Entity type:Individual
Prefix:
First Name:STERLING
Middle Name:C
Last Name:HICKSON
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1905 DOVE CROSSING LN STE C
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-5272
Mailing Address - Country:US
Mailing Address - Phone:936-825-0000
Mailing Address - Fax:936-825-8001
Practice Address - Street 1:1905 DOVE CROSSING LN STE C
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-5272
Practice Address - Country:US
Practice Address - Phone:936-825-0000
Practice Address - Fax:936-825-8001
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700973187OtherNPI CLINIC
TX45-1981OtherMEDICARE-FQHC