Provider Demographics
NPI:1396168985
Name:CHILDS-HICKS, DEMETRIC (CRNP)
Entity type:Individual
Prefix:
First Name:DEMETRIC
Middle Name:
Last Name:CHILDS-HICKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 SELMA AVE
Mailing Address - Street 2:P.O. BOX 2213
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-5825
Mailing Address - Country:US
Mailing Address - Phone:334-874-7428
Mailing Address - Fax:
Practice Address - Street 1:228 SELMA AVE
Practice Address - Street 2:POST OFFICE BOX 2213
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-5825
Practice Address - Country:US
Practice Address - Phone:334-874-7428
Practice Address - Fax:334-874-7435
Is Sole Proprietor?:No
Enumeration Date:2014-02-02
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-089829363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health