Provider Demographics
NPI:1255146692
Name:HICKS, BRYAN ANTHONY
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ANTHONY
Last Name:HICKS
Suffix:
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 1:4201 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5158
Mailing Address - Country:US
Mailing Address - Phone:402-601-2801
Mailing Address - Fax:
Practice Address - Street 1:4201 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5158
Practice Address - Country:US
Practice Address - Phone:402-601-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home