Provider Demographics
NPI:1023727930
Name:HICKS, MICKEY SR
Entity type:Individual
Prefix:MR
First Name:MICKEY
Middle Name:
Last Name:HICKS
Suffix:SR
Gender:M
Credentials:
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 532
Mailing Address - Street 2:
Mailing Address - City:HUGHES SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75656-0532
Mailing Address - Country:US
Mailing Address - Phone:972-639-2866
Mailing Address - Fax:
Practice Address - Street 1:600 RENAISSANCE PL
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1766
Practice Address - Country:US
Practice Address - Phone:972-639-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide