Provider Demographics
NPI:1184455420
Name:HICKS, KESHAWN (RN)
Entity type:Individual
Prefix:
First Name:KESHAWN
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KESHAWN
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1124 RED WOLF LN
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7448
Mailing Address - Country:US
Mailing Address - Phone:678-517-3521
Mailing Address - Fax:
Practice Address - Street 1:1124 RED WOLF LN
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7448
Practice Address - Country:US
Practice Address - Phone:678-517-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197191163WP0000X, 163WW0000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No251J00000XAgenciesNursing Care