Provider Demographics
NPI:1134626625
Name:HICKS, LINDSAY MICHAELA (APRN)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MICHAELA
Last Name:HICKS
Suffix:
Gender:F
Credentials:APRN
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 709
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-0709
Mailing Address - Country:US
Mailing Address - Phone:423-452-9984
Mailing Address - Fax:423-452-9980
Practice Address - Street 1:126 LAVENDER ST
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-5102
Practice Address - Country:US
Practice Address - Phone:423-452-9984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily