Provider Demographics
NPI:1295396646
Name:HICKEY, KEVIN D
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:HICKEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 ARCTIC BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4580
Mailing Address - Country:US
Mailing Address - Phone:907-333-4343
Mailing Address - Fax:907-333-4383
Practice Address - Street 1:3330 ARCTIC BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4580
Practice Address - Country:US
Practice Address - Phone:907-333-4343
Practice Address - Fax:907-333-4843
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator