Provider Demographics
NPI:1184286999
Name:HICKS, ANIECIA VICTORIA (PA)
Entity type:Individual
Prefix:
First Name:ANIECIA
Middle Name:VICTORIA
Last Name:HICKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25533 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-1681
Mailing Address - Country:US
Mailing Address - Phone:303-888-6344
Mailing Address - Fax:
Practice Address - Street 1:102 HAYS AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-2866
Practice Address - Country:US
Practice Address - Phone:970-521-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine