Provider Demographics
NPI:1023226917
Name:HICKS, NAKIMIA IV
Entity type:Individual
Prefix:MS
First Name:NAKIMIA
Middle Name:
Last Name:HICKS
Suffix:IV
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 1:416 RED RIVER TRL
Mailing Address - Street 2:2054
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4523
Mailing Address - Country:US
Mailing Address - Phone:214-331-0123
Mailing Address - Fax:
Practice Address - Street 1:1353 N WESTMORELAND RD
Practice Address - Street 2:BLDG C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1655
Practice Address - Country:US
Practice Address - Phone:214-331-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services