Provider Demographics
NPI:1356343941
Name:HICKEY, KENNETH S (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:HICKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 PARKERS HILL DR
Mailing Address - Street 2:
Mailing Address - City:MAIDENS
Mailing Address - State:VA
Mailing Address - Zip Code:23102-2244
Mailing Address - Country:US
Mailing Address - Phone:804-556-5170
Mailing Address - Fax:
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:ST FRANCIS EMERGENCY DEPARTMENT
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-287-7066
Practice Address - Fax:804-673-9531
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233603207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356343941Medicaid
VA232562OtherBLUE SHIELD
VA114228OtherBLUE SHILED
VA114708OtherBLUE SHIELD
VA204990OtherBLUE SHIELD
VA234124OtherBLUE SHIELD
VA019071V68Medicare UPIN
VA234124OtherBLUE SHIELD
VA232562OtherBLUE SHIELD
VAMC10581Medicare PIN
VAH90469Medicare UPIN
VA019073V01Medicare PIN