Provider Demographics
NPI:1356099337
Name:HICKS, PANSY ANN
Entity type:Individual
Prefix:
First Name:PANSY
Middle Name:ANN
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 DOT AVE
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-2780
Mailing Address - Country:US
Mailing Address - Phone:940-224-1089
Mailing Address - Fax:
Practice Address - Street 1:513 DOT AVE
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-2780
Practice Address - Country:US
Practice Address - Phone:940-224-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor